Provider Demographics
NPI:1578517074
Name:MEYERDIERKS, ELIZABETH M (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MEYERDIERKS
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 1:300 W NORTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6111
Mailing Address - Country:US
Mailing Address - Phone:336-275-0927
Mailing Address - Fax:336-275-4834
Practice Address - Street 1:300 W NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6111
Practice Address - Country:US
Practice Address - Phone:336-275-0927
Practice Address - Fax:336-275-4834
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31587207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200032540OtherRAILROAD MEDICARE
NC6958776Medicaid
NC200032540OtherRAILROAD MEDICARE
C85528Medicare UPIN