Provider Demographics
NPI:1952320905
Name:ELLIOTT, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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 1:1916 MONTAIGNE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4250
Mailing Address - Country:US
Mailing Address - Phone:804-272-2878
Mailing Address - Fax:
Practice Address - Street 1:8921 THREE CHOPT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4601
Practice Address - Country:US
Practice Address - Phone:804-285-4133
Practice Address - Fax:804-285-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86515208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952320905Medicaid
CA00G865150Medicaid
VA010416043Medicaid
P00768139Medicare PIN
CA00G865150Medicare ID - Type UnspecifiedMEDICARE
CA00G865150Medicaid
VA010416043Medicaid