Basic Information
| Provider Information | |||||||||
| NPI: | 1881661395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVERA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13336 ELLIOTT DRIVE | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109711139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6541 NORTH FEDERAL HWY SUITE 800 | ||||||||
| Address2: | WEATHERLY HEALTHCARE LOCUMS INC | ||||||||
| City: | FT. LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005865022 | ||||||||
| FaxNumber: | 8006036983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 04/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D37695 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 228871100 | 05 | MD | MEDICAID | 022004300 | 05 | MD | MEDICAID |