Basic Information
| Provider Information | |||||||||
| NPI: | 1619953049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | GAVIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 MICHIGAN AVE NW | ||||||||
| Address2: | DIVISION OF ANESTHESIOLOGY AND PAIN MEDICINE | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024762025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 MICHIGAN AVENUE NW | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D0052281 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 000034305 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | ME101307 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207LP3000X | 43087 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207LP3000X | MD044547E | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207LP3000X | MD037763 | DC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 4760 | 01 | PARTNERS | OTHER | 7205732 | 05 | VA | MEDICAID | 8930524 | 05 | NC | MEDICAID | 196843000 | 05 | WV | MEDICAID | 30524 | 01 | BCBS | OTHER | 96251 | 01 | MEDCOST | OTHER | Q34305 | 05 | SC | MEDICAID | 7352822 | 01 | AETNA | OTHER |