Provider Demographics
NPI:1750720553
Name:ACEVEDO DIAZ, ELIA ENID (MD)
Entity type:Individual
Prefix:MS
First Name:ELIA
Middle Name:ENID
Last Name:ACEVEDO DIAZ
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 1:9318 GAITHER RD STE 220
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1409
Mailing Address - Country:US
Mailing Address - Phone:301-251-4702
Mailing Address - Fax:301-251-4703
Practice Address - Street 1:9318 GAITHER RD STE 220
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1409
Practice Address - Country:US
Practice Address - Phone:301-251-4702
Practice Address - Fax:301-251-4703
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00836412084P0800X
PR29540R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry