Provider Demographics
NPI:1457655318
Name:MICHELLE, ELIZABETH HARLAN (MD)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:HARLAN
Last Name:MICHELLE
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 1:855 N WOLFE ST
Mailing Address - Street 2:RANGOS BUILDING, ROOM 248
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1503
Mailing Address - Country:US
Mailing Address - Phone:410-614-1196
Mailing Address - Fax:410-502-5459
Practice Address - Street 1:5051 GREENSPRING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4354
Practice Address - Country:US
Practice Address - Phone:410-601-9515
Practice Address - Fax:410-601-8905
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD812712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program