Provider Demographics
NPI:1235187725
Name:PALUMBO, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7015C MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3253
Mailing Address - Country:US
Mailing Address - Phone:703-971-6900
Mailing Address - Fax:703-972-9167
Practice Address - Street 1:10527 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2247
Practice Address - Country:US
Practice Address - Phone:703-425-3300
Practice Address - Fax:703-323-3950
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101222797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6714404Medicaid
VA6733972Medicaid