Provider Demographics
NPI:1992780662
Name:WATTS, ELIZABETH H (MD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:H
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:410 MAPLE AVENUE WEST
Mailing Address - Street 2:STE. 5
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-938-2244
Mailing Address - Fax:703-938-3669
Practice Address - Street 1:410 MAPLE AVENUE WEST
Practice Address - Street 2:STE. 5
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-938-2244
Practice Address - Fax:703-938-3669
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006723365Medicaid
F79052Medicare UPIN