Provider Demographics
NPI:1841488954
Name:ELIZABETH A. LIOTTA, M.D.,L.L.C
Entity type:Organization
Organization Name:ELIZABETH A. LIOTTA, M.D.,L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-668-3004
Mailing Address - Street 1:77 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4893
Mailing Address - Country:US
Mailing Address - Phone:301-668-3004
Mailing Address - Fax:301-668-3005
Practice Address - Street 1:77 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4893
Practice Address - Country:US
Practice Address - Phone:301-668-3004
Practice Address - Fax:301-668-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61563304OtherBLUE CROSS/BLUE SHIELD MD
MD3951050OtherAETNA HMO
MD5384008OtherAETNA PPO
DCG02088OtherMEDICARE OF DC
MD349576OtherUNITED HEALTHCARE
MD930BEAOtherBLUE CROSS/BLUE SHIELD MD
DCK614OtherBLUE CROSS/BLUE SHIELD DC
DC0001OtherBLUE CROSS/BLUE SHIELD DC
MD6999637OtherCIGNA
DCG02088E01OtherMEDICARE OF DC
MD3951050OtherAETNA HMO
DC0001OtherBLUE CROSS/BLUE SHIELD DC