1376549212 NPI number — ELIZABETH A PROSSER M.D.,F.A.C.P.

Table of content: ELIZABETH A PROSSER M.D.,F.A.C.P. (NPI 1376549212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376549212 NPI number — ELIZABETH A PROSSER M.D.,F.A.C.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROSSER
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.,F.A.C.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376549212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3515 MASSILLON RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44685-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-899-9350
Provider Business Mailing Address Fax Number:
330-634-1329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1917 WILLIAMSBURG WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44641-8781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-875-3366
Provider Business Practice Location Address Fax Number:
330-875-1106
Provider Enumeration Date:
06/24/2005

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: 207R00000X , with the licence number:  35-05-3562 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0628164 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".