Healthcare Provider Details

I. General information

NPI: 1578517074
Provider Name (Legal Business Name): ELIZABETH M MEYERDIERKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W NORTHWOOD ST
GREENSBORO NC
27401-6111
US

IV. Provider business mailing address

300 W NORTHWOOD ST
GREENSBORO NC
27401-6111
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-0927
  • Fax: 336-275-4834
Mailing address:
  • Phone: 336-275-0927
  • Fax: 336-275-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number31587
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: