Healthcare Provider Details

I. General information

NPI: 1437158631
Provider Name (Legal Business Name): ELISABETH TAYLOR CARDWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S MAIN ST SUITE B06
WOODSTOCK VA
22664-1143
US

IV. Provider business mailing address

755 S MAIN ST SUITE B06
WOODSTOCK VA
22664-1143
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1254
  • Fax: 540-459-1256
Mailing address:
  • Phone: 540-459-1254
  • Fax: 540-459-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101046935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: