Healthcare Provider Details

I. General information

NPI: 1205068723
Provider Name (Legal Business Name): ELIZABETH INNES DEANS THOMASON MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENT DR DEPT OB
DURHAM NC
27710-3037
US

IV. Provider business mailing address

200 TRENT DR DEPT OB
DURHAM NC
27710-3037
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-0296
  • Fax: 919-681-0739
Mailing address:
  • Phone: 919-668-0296
  • Fax: 919-681-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number069572
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2015-01283
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: