Basic Information
| Provider Information | |||||||||
| NPI: | 1417360330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6104 OLD BRANCH AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPLE HILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207482518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017026104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3209 COLONIAL DRIVE | ||||||||
| Address2: | FAMILY MEDICINE CENTER | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346113 | ||||||||
| FaxNumber: | 8034348478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LL37071 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.