Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101045949 | VA |
Y | 2080P0214X | Pediatric Pulmonologist | 0101045949 | VA |
NPI | 1295839629 |
---|---|
Provider Name | Dr. Gregory R Elliott |
First Address | Richmond, VA 23226-1934 |
Second Address | Richmond, VA 23226-1934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 10/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295839629 | (05) | VA |
C06778 | GROUP PTAN (01) | VA |
D81965 | (02) |