Individual
ELIZABETH MITTENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 632-2174
Mailing address
375 BOYLSTON ST, BROOKLINE, MA 02445-6007
(857) 307-0896
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
273553
MA
2086X0206X
Surgical Oncology Physician
M1941
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177303801
—
TX
Enumeration date
10/12/2006
Last updated
04/10/2018
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