Healthcare Provider Details

I. General information

NPI: 1235187725
Provider Name (Legal Business Name): ELIZABETH PALUMBO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10527 BRADDOCK RD
FAIRFAX VA
22032-2247
US

IV. Provider business mailing address

7015C MANCHESTER BLVD
ALEXANDRIA VA
22310-3253
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-3300
  • Fax: 703-323-3950
Mailing address:
  • Phone: 703-971-6900
  • Fax: 703-972-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101222797
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: