Healthcare Provider Details

I. General information

NPI: 1851316210
Provider Name (Legal Business Name): ELIZABETH A BUETOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR
RICHMOND VA
23235-4730
US

IV. Provider business mailing address

PO BOX 17694
BALTIMORE MD
21297-1694
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-2000
  • Fax:
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD56581
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberLIMITED
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number208024
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101059120
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: