1235491721 NPI number — ELIZABETH NORA FOJTIK MD

Table of content: ELIZABETH NORA FOJTIK MD (NPI 1235491721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235491721 NPI number — ELIZABETH NORA FOJTIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOJTIK
Provider First Name:
ELIZABETH
Provider Middle Name:
NORA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOVANOVICH
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
NORA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235491721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 WILLIAM PENN PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-281-1836
Provider Business Mailing Address Fax Number:
919-313-1276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 HUFFMAN MILL RD STE 1300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-584-5544
Provider Business Practice Location Address Fax Number:
336-584-4436
Provider Enumeration Date:
06/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  2015-00301 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)