Basic Information
| Provider Information | |||||||||
| NPI: | 1487618286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | STONE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9834 BUSINESS WAY | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032571440 | ||||||||
| FaxNumber: | 7032574337 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033913654 | ||||||||
| FaxNumber: | 7033913049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 03/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 0101042785 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 0101042785 | VA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 010236975 | 05 | VA | MEDICAID |