Individual
ELISE C PIEBENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
130 S. BRYN MAWR AVE., BRYN MAWR, PA 19010-3121
(610) 526-3000
(302) 651-5948
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
11970
RI
208M00000X
Hospitalist Physician
Primary
MD421773
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EP59268
—
RI
Enumeration date
05/23/2006
Last updated
10/25/2011
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