Provider Demographics
NPI:1447558622
Name:MCDOWELL, ELIZABETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6156
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-2067
Practice Address - Street 1:4141 SHIPYARD BLVD
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6156
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1929363A00000X
NC0010-05764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I978297Medicare PIN