Provider Demographics
NPI:1669654901
Name:ELIZABETH D BRYAN MD PA
Entity Type:Organization
Organization Name:ELIZABETH D BRYAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BLLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8243
Mailing Address - Street 1:603 BEAMAN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2689
Mailing Address - Country:US
Mailing Address - Phone:910-592-8243
Mailing Address - Fax:910-592-1552
Practice Address - Street 1:603 BEAMAN ST STE 402
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2689
Practice Address - Country:US
Practice Address - Phone:910-592-8243
Practice Address - Fax:910-592-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400646173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137XRMedicaid
NC2339388Medicare PIN