Provider Demographics
NPI:1518962877
Name:FOX, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:184 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2330
Mailing Address - Country:US
Mailing Address - Phone:276-228-2008
Mailing Address - Fax:276-228-5598
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2330
Practice Address - Country:US
Practice Address - Phone:276-228-2008
Practice Address - Fax:276-228-5598
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236456207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA354672OtherANTHEM
VA2278757OtherCIGNA
VA328239OtherSOUTHERN HEALTH
VA7875706OtherAETNA
VA1518962877Medicaid
VA203230510OtherMEDCOST
VA1518962877OtherVIRGINIA PREMIER
VA2278757OtherCIGNA
VAI23048Medicare UPIN