Healthcare Provider Details

I. General information

NPI: 1104867795
Provider Name (Legal Business Name): DAVID M ELLISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7908 CINCINNATI DAYTON RD SUITE J
WEST CHESTER OH
45069-6608
US

IV. Provider business mailing address

7908 CINCINNATI DAYTON RD SUITE J
WEST CHESTER OH
45069-6608
US

V. Phone/Fax

Practice location:
  • Phone: 937-241-1830
  • Fax: 888-418-2057
Mailing address:
  • Phone: 937-241-1830
  • Fax: 888-418-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.082208
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-082208
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: