Provider Demographics
NPI:1619409166
Name:ELZA, BETHANY ELLEN (DO)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ELLEN
Last Name:ELZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ELLEN
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5352
Mailing Address - Fax:
Practice Address - Street 1:37 LAYMANTOWN RD
Practice Address - Street 2:
Practice Address - City:TROUTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24175-6635
Practice Address - Country:US
Practice Address - Phone:540-977-1436
Practice Address - Fax:540-977-4230
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206179207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine