Provider Demographics
NPI:1124080445
Name:ALBERTSON, ELIZABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:ALBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:ALBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4541 CHINABERRY LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4290
Mailing Address - Country:US
Mailing Address - Phone:336-972-1910
Mailing Address - Fax:
Practice Address - Street 1:3 GLEN COVE DR # 3
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4232
Practice Address - Country:US
Practice Address - Phone:207-301-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35996208800000X
MEMD22553208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2236346COtherMEDICARE
NC2344759OtherMEDICARE, GROUP
NCP00193953OtherRR MEDICARE
NC891032YMedicaid
NC2344759OtherMEDICARE, GROUP
NC891032YMedicaid