Provider Demographics
NPI:1780604207
Name:EMAMI, ELIZABETH ROYA (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROYA
Last Name:EMAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROYA
Other - Last Name:ZICKMUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5601 FISHERS FRY
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-9615
Mailing Address - Country:US
Mailing Address - Phone:516-512-2457
Mailing Address - Fax:
Practice Address - Street 1:585 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8128
Practice Address - Country:US
Practice Address - Phone:541-292-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214441208200000X
OR1968122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1091F1Medicare ID - Type Unspecified
NYH74659Medicare UPIN