Provider Demographics
NPI:1528017076
Name:MAYER, ELIZABETH A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:MAYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28555 STARBRIGHT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5662
Mailing Address - Country:US
Mailing Address - Phone:419-931-3030
Mailing Address - Fax:419-931-3046
Practice Address - Street 1:28555 STARBRIGHT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5662
Practice Address - Country:US
Practice Address - Phone:419-931-3030
Practice Address - Fax:419-931-3046
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5000158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000660552OtherBCBS
OH0067679Medicaid
P00808415OtherRR MEDICARE
000000660552OtherBCBS