Healthcare Provider Details

I. General information

NPI: 1700853298
Provider Name (Legal Business Name): NEIL M. ELLISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-0140
US

IV. Provider business mailing address

100 N ACADEMY AVE CREDENTIALS DEPT
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-7383
  • Fax: 570-271-7384
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD022682E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD022682E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: