Individual
DR. SUSAN TILLMAN ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4910 MASSACHUSETTS AVE NW, SUITE 308, WASHINGTON, DC 20016-4300
(202) 635-1000
(202) 503-1791
Mailing address
4910 MASSACHUSETTS AVE.,NW, SUITE 308, WASHINGTON, DC 20016-4382
(202) 695-1000
(202) 503-1791
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0101046205
VA
207N00000X
Dermatology Physician
Primary
MD18955
DC
208600000X
Surgery Physician
0101046205
VA
208600000X
Surgery Physician
MD18955
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
371029
NCPPO INS
—
01
—
4115128
AETNA INS
—
Enumeration date
07/12/2006
Last updated
01/15/2019
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