Provider Demographics
NPI:1376606566
Name:MYLES, ELIZABETH ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROCHELLE
Last Name:MYLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 016
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-526-8622
Mailing Address - Fax:202-526-5035
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 016
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-526-8622
Practice Address - Fax:202-526-5035
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC17830207RG0100X
MDD0041272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87658Medicare UPIN
MY674106Medicare ID - Type Unspecified