Provider Demographics
NPI:1467422501
Name:RESTINO, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RESTINO
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 1:6127 S HWY 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9220
Mailing Address - Country:US
Mailing Address - Phone:704-483-0340
Mailing Address - Fax:704-483-8217
Practice Address - Street 1:6127 HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9220
Practice Address - Country:US
Practice Address - Phone:704-483-0340
Practice Address - Fax:704-483-8217
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423434207P00000X, 207Q00000X
NC2009-01671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00787981OtherRAILROAD MEDICARE
NC5912991Medicaid
065081Medicare ID - Type Unspecified
NCP00787981OtherRAILROAD MEDICARE
H75238Medicare UPIN