Provider Demographics
NPI:1396794905
Name:CROGNALE, ELIZABETH JODY (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JODY
Last Name:CROGNALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7702 E PARHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4371
Mailing Address - Country:US
Mailing Address - Phone:804-288-7901
Mailing Address - Fax:804-273-9167
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-288-7901
Practice Address - Fax:804-273-9167
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5857465Medicaid
VAH27217Medicare UPIN