Healthcare Provider Details

I. General information

NPI: 1144415340
Provider Name (Legal Business Name): ELIZABETH ANN BRIERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HORIZON DR
RALEIGH NC
27615-4922
US

IV. Provider business mailing address

260 HORIZON DR
RALEIGH NC
27615-4922
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-0015
  • Fax: 919-277-0066
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-277-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200300125
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: