Provider Demographics
NPI:1265565626
Name:FELDMAN, ELIZABETH D (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:D
Last Name:FELDMAN
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 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8692
Practice Address - Street 1:1860 TOWN CENTER DR STE 460
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5901
Practice Address - Country:US
Practice Address - Phone:032-089-3957
Practice Address - Fax:703-437-6549
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD005934208600000X
DCMD034797208600000X
VA0101247354208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7578964OtherAETNA PPO
VA1265565626Medicaid
1674845OtherAETNA HMO
61690202OtherCAREFIRST
0010OtherCAREFIRST
DCP00894797OtherRAILROAD MEDICARE
7578964OtherAETNA PPO
MD400079000Medicaid
DC129495YT2Medicare PIN