Provider Demographics
NPI: | 1215904248 |
---|---|
Name: | NORMAN, ELIZABETH S (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | ELIZABETH |
Middle Name: | S |
Last Name: | NORMAN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3333 SILAS CREEK PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | WINSTON SALEM |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27103-3013 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-718-3734 |
Mailing Address - Fax: | 336-718-3547 |
Practice Address - Street 1: | 3333 SILAS CREEK PKWY |
Practice Address - Street 2: | |
Practice Address - City: | WINSTON SALEM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27103-3013 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-718-3734 |
Practice Address - Fax: | 336-718-3547 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-08 |
Last Update Date: | 2008-05-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 200100269 | 207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 207ZP0104X, 207ZP0105X, 207ZP0213X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 1404H | Other | BCBS OF NORTH CAROLINA |
NC | 5902275 | Medicaid | |
NC | 1404H | Other | BCBS OF NORTH CAROLINA |
NC | 2045496A | Medicare PIN | |
NC | 5902275 | Medicaid |