Healthcare Provider Details

I. General information

NPI: 1639512999
Provider Name (Legal Business Name): ELIZABETH KATE PROFFITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/22/2023
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6831
  • Fax: 804-628-1132
Mailing address:
  • Phone: 804-358-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101258988
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number316114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: