Provider Demographics
NPI:1811954894
Name:WANEK, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:WANEK
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 1:6 N POINTE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3187
Mailing Address - Country:US
Mailing Address - Phone:336-545-1020
Mailing Address - Fax:336-545-6090
Practice Address - Street 1:6 N POINTE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3187
Practice Address - Country:US
Practice Address - Phone:336-545-1020
Practice Address - Fax:336-545-6090
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38235208600000X
NC38325208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP4948164004OtherCIGNA
NC400071OtherTRIGON BLUECROSS
NC85561OtherBLUECROSS BLUESHIELD
NC8985561Medicaid
NC020053149OtherRAILROAD MEDICARE
NCP4948164004OtherCIGNA
NCE08484Medicare UPIN