Healthcare Provider Details

I. General information

NPI: 1700066842
Provider Name (Legal Business Name): ELISA J KUCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA J BERES MD

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 SUNSET LN STE 305
CULPEPER VA
22701-3979
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 540-321-3120
  • Fax: 540-321-3121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101250147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: