Provider Demographics
NPI:1447730965
Name:MEYER, ELAINE MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:FERREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S EADS ST APT 205
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4717
Mailing Address - Country:US
Mailing Address - Phone:810-923-9504
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant