Provider Demographics
NPI:1104026228
Name:DIERKING, ELIZABETH LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LINDA
Last Name:DIERKING
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Gender:F
Credentials:MD
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Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-691-3603
Mailing Address - Fax:610-861-8104
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-691-3603
Practice Address - Fax:610-861-8104
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2012-10-24
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Provider Licenses
StateLicense IDTaxonomies
PAMD437276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
156852EDSMedicare PIN