Healthcare Provider Details

I. General information

NPI: 1477611374
Provider Name (Legal Business Name): LINDA ELEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS ROAD
WOODBRIGE VA
22192-4044
US

IV. Provider business mailing address

KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax: 703-490-7635
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101048916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: