Provider Demographics
NPI:1568677326
Name:CHOMA, ELIZABETH GWEN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GWEN
Last Name:CHOMA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:SALTZSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:# 104
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-779-0699
Practice Address - Fax:703-779-7712
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009249363LP0200X
VA0024167904363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568677326Medicaid