Provider Demographics
NPI:1083618862
Name:ELIZABETH PERNAL, M.D., P.A.
Entity Type:Organization
Organization Name:ELIZABETH PERNAL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-860-5151
Mailing Address - Street 1:813A EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5943
Mailing Address - Country:US
Mailing Address - Phone:410-860-5151
Mailing Address - Fax:410-860-2026
Practice Address - Street 1:813A EASTERN SHORE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5943
Practice Address - Country:US
Practice Address - Phone:410-860-5151
Practice Address - Fax:410-860-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157QMedicare ID - Type Unspecified
MDF74365Medicare UPIN