Individual
JON ZACHARY ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 J CLYDE MORRIS BLVD, RIVERSIDE REGIONAL MEDICAL CENTER, NEWPORT NEWS, VA 23601-1929
(757) 594-4405
(757) 594-3547
Mailing address
PO BOX 12087, H088, NEWPORT NEWS, VA 23612-2087
(757) 867-6101
(757) 867-6587
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0102202576
VA
2085R0202X
Diagnostic Radiology Physician
OT011323
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00897137
RAILROAD MEDICARE
VA
Enumeration date
05/03/2007
Last updated
04/13/2011
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