Provider Demographics
NPI:1558588376
Name:HIATT, DAVID ELLIS (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIS
Last Name:HIATT
Suffix:
Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-821-7966
Mailing Address - Fax:703-734-1441
Practice Address - Street 1:6845 ELM STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6028
Practice Address - Country:US
Practice Address - Phone:703-821-7966
Practice Address - Fax:703-734-1441
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010454032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A 46566Medicare UPIN