Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101038287 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101038287 | VA |
NPI | 1144225277 |
---|---|
Provider Name | Dr. Kurtis Scott Elward |
First Address | Baltimore, MD 21279-0777 |
Second Address | Charlottesville, VA 22901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E62963 | (02) |