Active NPI
Susan Tillman Elliott, M.D.
- Dermatology Physician
- Washington, DC
National Provider Identifier
1659306157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD18955
- Practice address
- 4910 Massachusetts Ave NW
Suite 308
Washington, DC 20016-4300 - Phone
- (202) 635-1000
- Fax
- (202) 503-1791
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 0101046205 | VA | |
| Surgery Physician | 208600000X | MD18955 | DC | |
| Surgery Physician | 208600000X | 0101046205 | VA | |
| Dermatology Physician | 207N00000X | MD18955 | DC | Primary |
Addresses
Primary practice location
4910 Massachusetts Ave NW
Suite 308
Washington, DC 20016-4300
Mailing address
4910 Massachusetts Ave.,NW
Suite 308
Washington, DC 20016-4382
Phone (202) 695-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371029 | Other | NCPPO INS | |
| 4115128 | Other | AETNA INS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD18955 | DC | MD | Dermatology Physician |
| 0101046205 | VA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1659306157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4910 MASSACHUSETTS AVE.,NW",
"address_2": "SUITE 308",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200164382",
"telephone_number": "202-695-1000",
"fax_number": "202-503-1791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4910 MASSACHUSETTS AVE NW",
"address_2": "SUITE 308",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200164300",
"telephone_number": "202-635-1000",
"fax_number": "202-503-1791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "SUSAN",
"middle_name": "TILLMAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "VA",
"license": "0101046205",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "DC",
"license": "MD18955",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "VA",
"license": "0101046205",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "DC",
"license": "MD18955",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPPO INS",
"identifier": "371029",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INS",
"identifier": "4115128",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.