Healthcare Provider Details

I. General information

NPI: 1467416123
Provider Name (Legal Business Name): ELIZABETH D LANOUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BRAMBLETON AVE SUITE 100
NORFOLK VA
23510-1115
US

IV. Provider business mailing address

3241 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5260
US

V. Phone/Fax

Practice location:
  • Phone: 757-627-6220
  • Fax: 757-627-0200
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101045136
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: