Healthcare Provider Details

I. General information

NPI: 1386931657
Provider Name (Legal Business Name): ELISABETTA PRAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

4400 E WEST HWY APT. 532
BETHESDA MD
20814-4524
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-7834
  • Fax: 703-889-2280
Mailing address:
  • Phone: 301-215-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116023366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: