Provider Demographics
NPI:1801848197
Name:BROWN, ELIZABETH LANTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LANTZ
Last Name:BROWN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4607 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-414-2140
Mailing Address - Fax:304-250-9941
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-414-2140
Practice Address - Fax:304-250-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-08-16
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Provider Licenses
StateLicense IDTaxonomies
WV20430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1803923000Medicaid
WVH35308Medicare UPIN
WV1803923000Medicaid