Healthcare Provider Details

I. General information

NPI: 1215016878
Provider Name (Legal Business Name): GIOVANNI ELIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 JEFFERSON ST SW FL 2
ROANOKE VA
24014-2419
US

IV. Provider business mailing address

2013 JEFFERSON ST SW FL 2
ROANOKE VA
24014-2419
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0237
  • Fax: 540-982-2719
Mailing address:
  • Phone: 540-982-0237
  • Fax: 409-822-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA49978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number0101233436
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101233436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: