Provider Demographics
NPI:1912535816
Name:ANTOPOLSKY, LIZA (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:ANTOPOLSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 WISCONSIN AVE NW STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2143
Mailing Address - Country:US
Mailing Address - Phone:202-243-3400
Mailing Address - Fax:202-243-3234
Practice Address - Street 1:4200 WISCONSIN AVE NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:202-243-3400
Practice Address - Fax:202-243-3234
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101278569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program