Provider Demographics
NPI:1619953049
Name:ELLIOTT, WILLIAM GAVIN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GAVIN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:DIVISION OF ANESTHESIOLOGY AND PAIN MEDICINE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-2025
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVENUE NW
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-476-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052281207L00000X
NC000034305207L00000X
FLME101307207LP3000X
TN43087207LP3000X
PAMD044547E207LP3000X
DCMD037763207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4760OtherPARTNERS
VA7205732Medicaid
NC8930524Medicaid
WV196843000Medicaid
30524OtherBCBS
96251OtherMEDCOST
SCQ34305Medicaid
7352822OtherAETNA
NC2163655AMedicare PIN
E96907Medicare UPIN
SCQ34305Medicaid