Provider Demographics
NPI:1871652560
Name:ELLIOTT, GARTH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:GARTH
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 LOYAL LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6268
Mailing Address - Country:US
Mailing Address - Phone:757-764-6950
Mailing Address - Fax:757-764-0786
Practice Address - Street 1:LANGLEY AFB HOSPITAL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665
Practice Address - Country:US
Practice Address - Phone:757-764-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110 001052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant