Healthcare Provider Details

I. General information

NPI: 1053739953
Provider Name (Legal Business Name): ELIZABETH SARAH NOWAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRYSTAL SPRING AVE SW STE 301
ROANOKE VA
24014-2465
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7715
  • Fax: 540-981-7965
Mailing address:
  • Phone: 540-224-5715
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101265860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: