Healthcare Provider Details

I. General information

NPI: 1467896670
Provider Name (Legal Business Name): ELSIE ACHIENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WARWICK BLVD STE 410
NEWPORT NEWS VA
23601-2548
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5200
  • Fax: 757-534-5830
Mailing address:
  • Phone: 757-316-5800
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number0101267437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: