Individual
ELIZABETH ELLEN TILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
511 LISA CAROL DR, MOORESVILLE, NC 28115-7903
(704) 651-3907
Mailing address
511 LISA CAROL DR, MOORESVILLE, NC 28115-7903
(704) 651-3907
(704) 799-1627
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
95-00744
NC
208000000X
Pediatrics Physician
Primary
9500744
NC
2080A0000X
Pediatric Adolescent Medicine Physician
95-00744
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8983534
—
NC
Enumeration date
05/19/2006
Last updated
09/09/2024
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