Healthcare Provider Details

I. General information

NPI: 1740115823
Provider Name (Legal Business Name): ERIC ELLSWORTH MS, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 K ST NW FL 11
WASHINGTON DC
20006-1604
US

IV. Provider business mailing address

1625 K ST NW FL 11
WASHINGTON DC
20006-1604
US

V. Phone/Fax

Practice location:
  • Phone: 202-454-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: