MEDICARE: DR. ELIZABETH REISER KERR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	2022-01552	NC

General Provider Information

NPI Number	:	1760941876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH REISER KERR MD

Provider Business Mailing Address
First Line	:	4022 FREEDOM LAKE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2156
Country	:	US
Telephone Number	:	919-477-2202
Fax Number	:	919-471-2270

Provider Business Practice Location Address
First Line	:	4022 FREEDOM LAKE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2156
Country	:	US
Telephone Number	:	919-477-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	06/20/2022

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