Provider Demographics
NPI:1053380923
Name:FABENS, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:FABENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1114
Mailing Address - Country:US
Mailing Address - Phone:215-242-5000
Mailing Address - Fax:215-242-3951
Practice Address - Street 1:345 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1114
Practice Address - Country:US
Practice Address - Phone:215-242-5000
Practice Address - Fax:215-242-3951
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAMD038072E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7014465-57Medicaid
PA7014465-57Medicaid
PA159223H3NMedicare ID - Type Unspecified