Provider Demographics
NPI:1144494931
Name:STEIN, ELISA A (MD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:A
Last Name:STEIN
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 1:6318 JESSIE LN
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9887
Mailing Address - Country:US
Mailing Address - Phone:336-355-0353
Mailing Address - Fax:336-742-8860
Practice Address - Street 1:6318 JESSIE LN
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9887
Practice Address - Country:US
Practice Address - Phone:336-355-0353
Practice Address - Fax:336-742-8860
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011 01308208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920489Medicaid
NCNC7080AMedicare PIN