Provider Demographics
NPI:1144378449
Name:SAEZ, ELIZABETH H (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:SAEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 E FRANKLIN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4985
Practice Address - Country:US
Practice Address - Phone:704-468-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144378449Medicaid
SCWP8941Medicaid
SC1871PAMedicaid
NC8101936Medicaid
SC1172993OtherWELLCARE OF SC
SC30226461OtherSELECT HEALTH OF SC
SCWP8941Medicaid
NCNC3936BMedicare PIN
NC2768920NMedicare PIN
NC2347843Medicare UPIN
SC1172993OtherWELLCARE OF SC
SC30226461OtherSELECT HEALTH OF SC
NCNC3936CMedicare PIN
SC1871PAMedicaid
NC2768920PMedicare PIN
NC2768920FMedicare PIN