Provider Demographics
NPI:1043366628
Name:BLANK, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BLANK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:497 MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3190
Mailing Address - Country:US
Mailing Address - Phone:410-414-9840
Mailing Address - Fax:410-414-9841
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3190
Practice Address - Country:US
Practice Address - Phone:410-414-9840
Practice Address - Fax:410-414-9841
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-03-01
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Provider Licenses
StateLicense IDTaxonomies
171000000X
MDD0082740207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider