Provider Demographics
NPI:1053491704
Name:FOX, ELISABETH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:18316 BUCCANEER TER
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8474
Mailing Address - Country:US
Mailing Address - Phone:703-608-7313
Mailing Address - Fax:703-858-4489
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-858-4439
Practice Address - Fax:703-858-4489
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME28653207Y00000X
IA52525207Y00000X
VA0101222259207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004285O13Medicare ID - Type Unspecified