Provider Demographics
NPI:1790769180
Name:PALAVECINO, ELIZABETH LEONILA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEONILA
Last Name:PALAVECINO
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 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-7595
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-7595
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301032207ZM0300X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2005694000Medicaid
NC7067670OtherAETNA
NC803319OtherPARTNERS
VA10017807Medicaid
NC1341VOtherBCBS
NCC8207OtherMEDCOST
NC891341VMedicaid
VA10017807Medicaid
NC1341VOtherBCBS