Healthcare Provider Details

I. General information

NPI: 1871578112
Provider Name (Legal Business Name): JONATHAN SCOTT ELIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVE STE 415
ROCKVILLE MD
20850-3334
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-9400
  • Fax: 301-279-0313
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0033350
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0033350
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: