Provider Demographics
NPI:1871777532
Name:DEMARA, ELIZABETH B (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:DEMARA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 BRIGGS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4640
Mailing Address - Country:US
Mailing Address - Phone:856-235-7080
Mailing Address - Fax:856-273-0402
Practice Address - Street 1:2059 BRIGGS RD STE 304
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4640
Practice Address - Country:US
Practice Address - Phone:856-235-7080
Practice Address - Fax:856-273-0402
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00191700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119576AZDOtherMEDICARE PTAN NUMBER