Provider Demographics
NPI:1154396422
Name:ELIZABETH G SCHLENOFF MD PC
Entity type:Organization
Organization Name:ELIZABETH G SCHLENOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHLENOFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-357-5559
Mailing Address - Street 1:214 MT CARMEL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9750
Mailing Address - Country:US
Mailing Address - Phone:410-357-5559
Mailing Address - Fax:410-357-0308
Practice Address - Street 1:214 MT CARMEL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9750
Practice Address - Country:US
Practice Address - Phone:410-357-5559
Practice Address - Fax:410-357-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLP0ELOtherBC MARYLAND
MD080150059OtherRAILROAD MEDICARE
MD872232OtherUNITED HEALTHCARE
MD080150059OtherMEDICARE RAILROAD
DCR474OtherBC DC/METRO
080150059OtherMEDICARE RAILROAD
DCR474OtherBC DC/METRO
080150059OtherMEDICARE RAILROAD
E25344Medicare UPIN
MDLP0ELOtherBC MARYLAND