Provider Demographics
NPI:1821107772
Name:PRICE, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1907 S 17TH STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6656
Mailing Address - Country:US
Mailing Address - Phone:910-341-0011
Mailing Address - Fax:910-341-0012
Practice Address - Street 1:1907 S 17TH STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6656
Practice Address - Country:US
Practice Address - Phone:910-341-0011
Practice Address - Fax:910-341-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057810207W00000X
NC9700718207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3840631OtherAETNA
176811OtherANTHEM
365030OtherMDIPA
VA010159938Medicaid
0078660OtherCIGNA
259241OtherSOUTHERN HEALTH
176811OtherANTHEM
3840631OtherAETNA