Provider Demographics
NPI:1326273293
Name:DAHLBERG, ELIZABETH R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:DAHLBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 MERIDIAN PARKE LN
Mailing Address - Street 2:STE. E
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9420
Mailing Address - Country:US
Mailing Address - Phone:317-893-2364
Mailing Address - Fax:317-851-8066
Practice Address - Street 1:373 MERIDIAN PARKE LN
Practice Address - Street 2:STE. E
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9420
Practice Address - Country:US
Practice Address - Phone:317-893-2364
Practice Address - Fax:317-851-8066
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014889A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201068250Medicaid