Healthcare Provider Details

I. General information

NPI: 1972867521
Provider Name (Legal Business Name): LAUREN MICHELLE ELLIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MICHELLE FRANCIS

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE SUITE H321
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

130 S BRYN MAWR AVE SUITE H321
BRYN MAWR PA
19010-3121
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-4097
  • Fax: 484-337-4082
Mailing address:
  • Phone: 484-337-4097
  • Fax: 484-337-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS017652
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS017652
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: