MEDICARE: DR. LIZA HANNAH GOLD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	47590	VA
2	2084P0800X	Psychiatry Physician	47590	VA

General Provider Information

NPI Number	:	1366516387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIZA HANNAH GOLD MD

Provider Business Mailing Address
First Line	:	2501 N GLEBE RD
Second Line	:	SUITE 204
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-875-0435
Fax Number	:	703-875-0434

Provider Business Practice Location Address
First Line	:	2120 WASHINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5718
Country	:	US
Telephone Number	:	703-228-1600
Fax Number	:	703-228-1117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/16/2020

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