Provider Demographics
NPI:1831290055
Name:ELIZALDE, PABLO MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:MARTIN
Last Name:ELIZALDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-273-1100
Mailing Address - Fax:912-273-1111
Practice Address - Street 1:4700 WATERS AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-273-1100
Practice Address - Fax:912-273-1111
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00794571AMedicaid
GA00794571AMedicaid
GA06BDFTQMedicare ID - Type Unspecified