Individual
DR. ELIZABETH ANNE THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
55 FRUIT ST YAW 6B, PEDIATRIC NEUROLOGY, BOSTON, MA 02114
(617) 726-6540
(617) 726-0230
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-6540
(617) 726-0230
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
79261
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079261
TUFTS HEALTH PLAN
MA
05
—
3147088
—
MA
01
—
J16820
BCBS MA
MA
Enumeration date
02/24/2006
Last updated
02/19/2013
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