Provider Demographics
NPI:1861570269
Name:MEINE, ELIZABETH KAHN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAHN
Last Name:MEINE
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 1:1606 WELLINGTON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7704
Mailing Address - Country:US
Mailing Address - Phone:910-452-1999
Mailing Address - Fax:910-452-1883
Practice Address - Street 1:1606 WELLINGTON AVE STE E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7704
Practice Address - Country:US
Practice Address - Phone:910-452-1999
Practice Address - Fax:910-452-1883
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28870208000000X
NC200101097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC029Medicaid
SCFQC029Medicaid