Healthcare Provider Details

I. General information

NPI: 1013308808
Provider Name (Legal Business Name): ELIZABETH MYERS FISHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN MYERS PA-C

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER 7503 SURRATTS ROAD
CLINTON MD
20735
US

IV. Provider business mailing address

MEDSTAR SOUTHERN MARYLAND HOSPITAL CENTER 7503 SURRATTS ROAD
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-4505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-004867
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005964
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-004867
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031315
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110-004867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: