Healthcare Provider Details

I. General information

NPI: 1740864537
Provider Name (Legal Business Name): ELIZABETH PEPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 540-498-7930
  • Fax:
Mailing address:
  • Phone: 301-295-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2022047675
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2022047675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: