1528103678 NPI number — DR. ELIZABETH ANDERSON DICKINSON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528103678 NPI number — DR. ELIZABETH ANDERSON DICKINSON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DICKINSON

Provider First Name:

ELIZABETH

Provider Middle Name:

ANDERSON

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1528103678

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/01/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 3239

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FLORENCE

Provider Business Mailing Address State Name:

SC

Provider Business Mailing Address Postal Code:

29502-3239

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

843-777-6870

Provider Business Mailing Address Fax Number:

843-777-6871

Provider First Line Business Practice Location Address:

964 LOCHEND DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DARLINGTON

Provider Business Practice Location Address State Name:

SC

Provider Business Practice Location Address Postal Code:

29532-5698

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

843-777-6890

Provider Business Practice Location Address Fax Number:

843-777-6891

Provider Enumeration Date:

02/20/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207QA0505X , with the licence number:  12821 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 12821 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 128212 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 207167 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 034 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 062 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 000000240272 . This is a "UNISON" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 0422230 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 18500 . This is a "EVOLUTIONS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 5909339 . This is a "NC MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 063 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 063 . This is a "BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".