Healthcare Provider Details

I. General information

NPI: 1740254630
Provider Name (Legal Business Name): ELIZABETH A PINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0564
  • Fax: 812-242-3133
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01043717
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: