Healthcare Provider Details

I. General information

NPI: 1871989749
Provider Name (Legal Business Name): ELIZABETH BRUNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR STE 325
ARLINGTON VA
22205-3690
US

IV. Provider business mailing address

1625 N GEORGE MASON DR STE 325
ARLINGTON VA
22205-3690
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-4600
  • Fax: 703-717-4601
Mailing address:
  • Phone: 703-717-4600
  • Fax: 703-717-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD047258
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101272432
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101272432
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: