Provider Demographics
NPI:1437753811
Name:WATERMAN, ELAINE TWIGG (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:TWIGG
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 CASTLE PL STE 2A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1907
Mailing Address - Country:US
Mailing Address - Phone:703-373-7338
Mailing Address - Fax:
Practice Address - Street 1:6319 CASTLE PL STE 2A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1907
Practice Address - Country:US
Practice Address - Phone:703-373-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110007481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant