Provider Demographics
NPI:1558321182
Name:CEBALLOS, ELIZENDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZENDA
Middle Name:M
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:116 NATIONWIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4271
Mailing Address - Country:US
Mailing Address - Phone:434-947-3984
Mailing Address - Fax:434-947-5950
Practice Address - Street 1:116 NATIONWIDE DRIVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:54502-4271
Practice Address - Country:US
Practice Address - Phone:434-947-3984
Practice Address - Fax:434-947-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010230863207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA430205OtherANTHEM
VA1558321182Medicaid
180042502OtherMEDICARE RAILROAD
VA430205OtherANTHEM
H19221Medicare UPIN