Healthcare Provider Details

I. General information

NPI: 1710247291
Provider Name (Legal Business Name): ELIZABETH JOAN ARONSTAM KETTINGER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

305 PRESERVE DR
LYNCHBURG VA
24503-2907
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3101
  • Fax:
Mailing address:
  • Phone: 573-465-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101019919
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101019919
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102204142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: