Provider Demographics
NPI:1629015326
Name:BARNES, ELIZABETH S (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:BARNES
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:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-6515
Mailing Address - Fax:336-275-0812
Practice Address - Street 1:1210 NEW GARDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2721
Practice Address - Country:US
Practice Address - Phone:336-294-6190
Practice Address - Fax:336-294-6278
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077950207Q00000X
NC30863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191319Medicaid
OH000000197878OtherANTHEM BLUE CROSS/SHIELD
OH000000197878OtherANTHEM BLUE CROSS/SHIELD
OHBA2021573Medicare ID - Type UnspecifiedELO LOCATION
C86604Medicare UPIN
NC210704CMedicare PIN