Provider Demographics
NPI:1528103678
Name:DICKINSON, ELIZABETH ANDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANDERSON
Last Name:DICKINSON
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-6870
Mailing Address - Fax:843-777-6871
Practice Address - Street 1:964 LOCHEND DR
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-5698
Practice Address - Country:US
Practice Address - Phone:843-777-6890
Practice Address - Fax:843-777-6891
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12821207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128212Medicaid
SC207167OtherMEDCOST
SC034OtherTRICARE
SC062OtherBCBS
SC000000240272OtherUNISON
SC0422230OtherCIGNA
SC18500OtherEVOLUTIONS
NC5909339OtherNC MEDICAID
SC063OtherBCBS
SC063OtherBLUECHOICE
SC128212Medicaid