Provider Demographics
NPI:1932112182
Name:CHEA, ELIZABETH ANTON (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANTON
Last Name:CHEA
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:208 FRONTAGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1691
Practice Address - Country:US
Practice Address - Phone:864-654-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2981Medicaid
G89786Medicare UPIN