Provider Demographics
NPI:1174590996
Name:MONTEMURRO, ELIZABETH ANN (O D)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MONTEMURRO
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:WEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:1 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1659
Practice Address - Country:US
Practice Address - Phone:410-838-3200
Practice Address - Fax:410-838-0795
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE008359T152W00000X
MDTA1614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89750Medicare UPIN
270254YN2CMedicare PIN
270254YN2DMedicare PIN
237LMedicare ID - Type Unspecified