Provider Demographics
NPI:1366576415
Name:MANN, ELIZABETH M (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELIZABETH M OTT DO
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:STE 2400
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-7972
Mailing Address - Country:US
Mailing Address - Phone:812-858-4600
Mailing Address - Fax:812-858-4601
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-858-4600
Practice Address - Fax:812-858-4601
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003321A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200915200Medicaid
IN637080IIMedicare PIN