Provider Demographics
NPI:1093829947
Name:NGUYEN, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:516 PROSPECT AVE
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2523
Mailing Address - Country:US
Mailing Address - Phone:315-703-5270
Mailing Address - Fax:315-703-5271
Practice Address - Street 1:516 PROSPECT AVE
Practice Address - Street 2:PEDIATRICS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2523
Practice Address - Country:US
Practice Address - Phone:315-703-5270
Practice Address - Fax:315-703-5271
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY190623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01396818Medicaid