Provider Demographics
NPI:1043283278
Name:HARDEN, LIZABETH MAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZABETH
Middle Name:MAYA
Last Name:HARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIZABETH
Other - Middle Name:MAYA
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:132 WINDINGHAM DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4005
Mailing Address - Country:US
Mailing Address - Phone:256-830-6985
Mailing Address - Fax:256-551-6529
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 550
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-551-6526
Practice Address - Fax:256-551-6529
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080712Medicaid
ALC73435Medicare UPIN
AL000080712Medicaid