Healthcare Provider Details

I. General information

NPI: 1487570784
Provider Name (Legal Business Name): ELISABETH PICKETT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10417 METROPOLITAN AVE STE B
KENSINGTON MD
20895-2649
US

IV. Provider business mailing address

10417 METROPOLITAN AVE STE B
KENSINGTON MD
20895-2649
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-3722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: