Provider Demographics
NPI:1356345235
Name:PERNAL, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PERNAL
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 1:813A EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5943
Mailing Address - Country:US
Mailing Address - Phone:410-860-5151
Mailing Address - Fax:410-860-2026
Practice Address - Street 1:813A EASTERN SHORE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5943
Practice Address - Country:US
Practice Address - Phone:410-860-5151
Practice Address - Fax:410-860-2026
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD049321000Medicaid
MDF74365Medicare UPIN
MD158QMedicare ID - Type Unspecified