Provider Demographics
NPI:1043398969
Name:MULBERRY, ELIZABETH MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:MULBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3648
Mailing Address - Country:US
Mailing Address - Phone:336-763-0814
Mailing Address - Fax:336-763-0815
Practice Address - Street 1:238 S ENGLISH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3648
Practice Address - Country:US
Practice Address - Phone:336-763-0814
Practice Address - Fax:336-763-0815
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001414207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127U7OtherBCBS OF NC
NC39154OtherPARTNERS MEDICARE
NC2281410BMedicare PIN
NC110214297Medicare ID - Type UnspecifiedRR MEDICARE
F77453Medicare UPIN