Provider Demographics
NPI:1275594772
Name:HENKE, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HENKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-5297
Mailing Address - Fax:
Practice Address - Street 1:1821 HILLANDALE RD
Practice Address - Street 2:SUITE 25C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2659
Practice Address - Country:US
Practice Address - Phone:919-220-5510
Practice Address - Fax:919-220-6536
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23228207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941594Medicaid
NC8941594Medicaid