Provider Demographics
NPI:1245207273
Name:CERVA, ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CERVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 E YORK ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3026
Mailing Address - Country:US
Mailing Address - Phone:215-203-8012
Mailing Address - Fax:215-203-8109
Practice Address - Street 1:2424 E YORK ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3026
Practice Address - Country:US
Practice Address - Phone:215-203-8012
Practice Address - Fax:215-203-8109
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007831207Q00000X
NY286151207Q00000X
GA77356207Q00000X
IN02004945A207Q00000X
MDH82458207Q00000X
MN61627207Q00000X
CA20A15427207Q00000X
PAOS006828L207Q00000X
NJ25MB09093800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00112394120003Medicaid
NJ0364894Medicaid
PA663337YEBK - 213827Medicare PIN
NJ0364894Medicaid
0000663337Medicare ID - Type Unspecified
NJ310909C04Medicare PIN