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NPI Code Detail

MEDICARE: DR. HALLE BEITOLLAHI ELLISON M.D.

MEDICARE: DR. HALLE BEITOLLAHI ELLISON 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
12086H0002XHospice and Palliative Medicine (Surgery) PhysicianMD451876PA

General Provider Information

NPI Number : 1598907743
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HALLE BEITOLLAHI ELLISON M.D.
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-6144
Fax Number :
Provider Business Practice Location Address
First Line : 9 STEARNS LN
Second Line :
City : DANVILLE
State : PA
Zip : 17821-8850
Country : US
Telephone Number : 570-271-6784
Fax Number : 570-271-5268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 03/13/2025

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