Healthcare Provider Details

I. General information

NPI: 1144226630
Provider Name (Legal Business Name): JAMES M ELLISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST SWANK MEMORY CARE CENTER, GATEWAY BLDG, 5TH FLOOR
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST SWANK MEMORY CARE CENTER, GATEWAY BLDG 5TH FLOOR
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2637
  • Fax: 844-634-0254
Mailing address:
  • Phone: 302-320-2637
  • Fax: 844-634-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44908
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number44908
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC-0011443
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: