Individual
ELIZABETH C DETERDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
520 N ELAM AVE, GREENSBORO, NC 27403-1127
(336) 547-1801
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
9601589
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129N5
BCBS
—
05
—
2005256000
—
WV
01
—
390008126
RR MEDICARE
—
01
—
43078
PARTNERS
—
05
—
5881447
—
VA
01
—
7644357
AETNA
—
05
—
89129N5
—
NC
01
—
D0554
MEDCOST
—
05
—
Q01589
—
SC
Enumeration date
03/10/2006
Last updated
10/27/2020
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