Healthcare Provider Details

I. General information

NPI: 1245694322
Provider Name (Legal Business Name): ELIZABETH ASHTON OCKERMAN HUBBARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

913 W ST NW
WASHINGTON DC
20001-4031
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-1577
  • Fax:
Mailing address:
  • Phone: 615-351-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD048397
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD048397
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: