Provider Demographics
NPI:1134787062
Name:CONLON, ELIZABETH GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GRACE
Last Name:CONLON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20508 HIGHLAND HALL DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4003
Mailing Address - Country:US
Mailing Address - Phone:301-305-6418
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:301-305-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270319207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicaid