Healthcare Provider Details

I. General information

NPI: 1508850454
Provider Name (Legal Business Name): ELIZABETH DE FALCON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH DE FALCON MD

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5747
US

IV. Provider business mailing address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5747
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7337
  • Fax:
Mailing address:
  • Phone: 757-564-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101260630
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: