Provider Demographics
NPI:1972785582
Name:SZELKOWSKI, LIZA ANN (PA)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:ANN
Last Name:SZELKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ANN
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:PHYSICIAN BILLING
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-2545
Practice Address - Fax:703-776-2917
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10201Medicare UPIN