Provider Demographics
NPI:1477026771
Name:GOLD, ELIZABETH CASEY (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CASEY
Last Name:GOLD
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD STE 365
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3739
Mailing Address - Country:US
Mailing Address - Phone:412-469-7915
Mailing Address - Fax:412-469-7916
Practice Address - Street 1:575 COAL VALLEY RD STE 365
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3739
Practice Address - Country:US
Practice Address - Phone:412-469-7915
Practice Address - Fax:412-469-7916
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103660044Medicaid