Provider Demographics
NPI:1295849248
Name:ELLIOTT, JOHN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFREY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3616
Mailing Address - Country:US
Mailing Address - Phone:703-525-8800
Mailing Address - Fax:703-525-8830
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE # 300
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3616
Practice Address - Country:US
Practice Address - Phone:703-525-8800
Practice Address - Fax:703-525-8830
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101033155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01663Medicare PIN
VAC62690Medicare UPIN