Provider Demographics
NPI:1982929832
Name:ELLIOTT, OLGA ALEKSANDROVNA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:ALEKSANDROVNA
Last Name:ELLIOTT
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 1:1380 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7751
Mailing Address - Country:US
Mailing Address - Phone:757-252-9800
Mailing Address - Fax:
Practice Address - Street 1:1380 TUSCANY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-7751
Practice Address - Country:US
Practice Address - Phone:757-252-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB579AMedicare PIN