Healthcare Provider Details

I. General information

NPI: 1285801092
Provider Name (Legal Business Name): ELIZABETH P. D. PONTIUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW # NA1177
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW # NA1177
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2525
  • Fax:
Mailing address:
  • Phone: 202-877-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD038587
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0070448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: