Provider Demographics
NPI:1568568038
Name:O'DONOGHUE, ELIZABETH ELLIOTT (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ELLIOTT
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 GARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2936
Mailing Address - Country:US
Mailing Address - Phone:301-495-9370
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1555
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-951-8593
Practice Address - Fax:301-951-8598
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1452-0003OtherCAREFIRST
DCQ18242Medicare UPIN
DC014445M60Medicare ID - Type UnspecifiedMEDICARE