Provider Demographics
NPI:1972566735
Name:VANDERGRIFF, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VANDERGRIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3600 NW CARY PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8444
Mailing Address - Country:US
Mailing Address - Phone:919-319-9219
Mailing Address - Fax:919-481-1716
Practice Address - Street 1:110 PRESTON EXECUTIVE DR # A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8447
Practice Address - Country:US
Practice Address - Phone:919-319-9219
Practice Address - Fax:919-481-1716
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01540Medicare UPIN
NC2209964BMedicare ID - Type Unspecified