Provider Demographics
NPI:1184810574
Name:JOHNSON, ELIZABETH COLELLA (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COLELLA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DIANN
Other - Last Name:COLELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3022 WILLIAMS DR #300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-573-9800
Mailing Address - Fax:703-738-5777
Practice Address - Street 1:3022 WILLIAMS DR #300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-573-9800
Practice Address - Fax:703-738-5777
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA556090Medicare UPIN