Provider Demographics
NPI:1346214517
Name:HALABUK, ELIZABETH ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANDERSON
Last Name:HALABUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:F
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-222-0002
Mailing Address - Fax:703-652-9996
Practice Address - Street 1:12011 LEE JACKSON MEMORIAL HWY STE 230
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3310
Practice Address - Country:US
Practice Address - Phone:703-222-0002
Practice Address - Fax:703-652-9996
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01992Medicare PIN
VAH06487Medicare UPIN