Healthcare Provider Details

I. General information

NPI: 1376190009
Provider Name (Legal Business Name): TAYLOR ELIZABETH RAUM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR ELIZABETH ROUSE

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E MAIN ST
NEWARK DE
19711-7150
US

IV. Provider business mailing address

26421 AIKEN DR
CLARKSBURG MD
20871-9635
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-4300
  • Fax:
Mailing address:
  • Phone: 240-997-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC07405
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07405
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: