Provider Demographics
NPI:1275899981
Name:CENGIA, MA ELIZABETH DIONISIO (MD)
Entity Type:Individual
Prefix:
First Name:MA ELIZABETH
Middle Name:DIONISIO
Last Name:CENGIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA ELIZABETH
Other - Middle Name:DIOKNO
Other - Last Name:DIONISIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5110 ROBINHOOD VILLAGE DR STE C-1
Practice Address - Street 2:SUITE C-1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9825
Practice Address - Country:US
Practice Address - Phone:336-277-7030
Practice Address - Fax:336-277-7040
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2015-00490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program