Provider Demographics
NPI:1760540421
Name:TILSON, ELIZABETH CUERVO (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CUERVO
Last Name:TILSON
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 1:10 SUNNYBROOK RD
Mailing Address - Street 2:CHILD HEALTH CLINIC- WAKE COUNTY HUMAN SERVICES
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1808
Mailing Address - Country:US
Mailing Address - Phone:919-250-3988
Mailing Address - Fax:919-250-4581
Practice Address - Street 1:10 SUNNYBROOK RD
Practice Address - Street 2:CHILD HEALTH CLINIC- WAKE COUNTY HUMAN SERVICES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1808
Practice Address - Country:US
Practice Address - Phone:919-250-3988
Practice Address - Fax:919-250-4581
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911555Medicaid
NCG31378Medicare UPIN