MEDICARE: DR. JAMES M ELLISON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	44908	MA
2	2084P0805X	Geriatric Psychiatry Physician	44908	MA
3	2084P0805X	Geriatric Psychiatry Physician	C-0011443	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144226630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M ELLISON MD

Provider Business Mailing Address
First Line	:	501 W 14TH ST
Second Line	:	SWANK MEMORY CARE CENTER, GATEWAY BLDG 5TH FLOOR
City	:	WILMINGTON
State	:	DE
Zip	:	19801-1013
Country	:	US
Telephone Number	:	302-320-2637
Fax Number	:	844-634-0254

Provider Business Practice Location Address
First Line	:	501 W 14TH ST
Second Line	:	SWANK MEMORY CARE CENTER, GATEWAY BLDG, 5TH FLOOR
City	:	WILMINGTON
State	:	DE
Zip	:	19801-1013
Country	:	US
Telephone Number	:	302-320-2637
Fax Number	:	844-634-0254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/25/2023

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