Provider Demographics
NPI:1316225550
Name:SUSAN TILLMAN ELLIOTT
Entity Type:Organization
Organization Name:SUSAN TILLMAN ELLIOTT
Other - Org Name:FOXHALL DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:TILLMAN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-695-1000
Mailing Address - Street 1:4910 MASSACHUSETTS AVE.,NW
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4382
Mailing Address - Country:US
Mailing Address - Phone:202-695-1000
Mailing Address - Fax:202-503-1791
Practice Address - Street 1:4910 MASSACHUSETTS AVE.,NW
Practice Address - Street 2:SUITE 308
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4382
Practice Address - Country:US
Practice Address - Phone:202-695-1000
Practice Address - Fax:202-503-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC18955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty