Provider Demographics
NPI:1396834974
Name:ELIEZER, ELAINE TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:TERESA
Last Name:ELIEZER
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 1:823A SOUTH KING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3920
Mailing Address - Country:US
Mailing Address - Phone:703-771-9330
Mailing Address - Fax:703-771-9333
Practice Address - Street 1:823A SOUTH KING ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3920
Practice Address - Country:US
Practice Address - Phone:703-771-9330
Practice Address - Fax:703-771-9333
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035559207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA232552OtherBLUE CROSS BLUE SHIELD
VA232552OtherBLUE CROSS BLUE SHIELD