Provider Demographics
NPI:1881661395
Name:OLIVERA, ELIZABETH KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KAY
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13336 ELLIOTT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029
Mailing Address - Country:US
Mailing Address - Phone:410-971-1139
Mailing Address - Fax:
Practice Address - Street 1:6541 NORTH FEDERAL HWY SUITE 800
Practice Address - Street 2:WEATHERLY HEALTHCARE LOCUMS INC
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:800-586-5022
Practice Address - Fax:800-603-6983
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37695208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD228871100Medicaid
MD022004300Medicaid
MDE30518Medicare UPIN
MD022004300Medicaid