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NPI Code Detail

MEDICARE: DR. JAMES ANDREW ELLZY II M.D.

MEDICARE: DR. JAMES ANDREW ELLZY II M.D.
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
1207Q00000XFamily Medicine PhysicianA064662CA
2207Q00000XFamily Medicine PhysicianD0069949MD

General Provider Information

NPI Number : 1417949736
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES ANDREW ELLZY II M.D.
Provider Business Mailing Address
First Line : 3214 10TH ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20017-3510
Country : US
Telephone Number : 619-300-9639
Fax Number :
Provider Business Practice Location Address
First Line : 9300 DEWITT LOOP
Second Line :
City : FORT BELVOIR
State : VA
Zip : 22060-5285
Country : US
Telephone Number : 703-681-0064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 06/04/2025

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