Healthcare Provider Details

I. General information

NPI: 1043578354
Provider Name (Legal Business Name): ELIZABETH THERIAULT LION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 NORTHCROSS DR UNIT 9027
AUSTIN TX
78766-4003
US

IV. Provider business mailing address

7700 NORTHCROSS DR UNIT 9027
AUSTIN TX
78766-4003
US

V. Phone/Fax

Practice location:
  • Phone: 202-577-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0054889
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT1999
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: