Provider Demographics
NPI:1275259616
Name:IOANNIDIS, ELENI ZOE
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:ZOE
Last Name:IOANNIDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 DEMOCRACY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7500
Mailing Address - Country:US
Mailing Address - Phone:443-351-4650
Mailing Address - Fax:
Practice Address - Street 1:15204 OMEGA DR STE 310
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4816
Practice Address - Country:US
Practice Address - Phone:240-361-9000
Practice Address - Fax:240-361-9001
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant