Healthcare Provider Details

I. General information

NPI: 1225072747
Provider Name (Legal Business Name): CHRISTINA E ELLIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

728 W LINCOLN HWY
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-903-6200
  • Fax: 610-429-1057
Mailing address:
  • Phone: 610-903-6200
  • Fax: 610-429-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD035003E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1301335
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 2
Identifier0011279710007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier0091952000
Identifier TypeOTHER
Identifier State
Identifier IssuerINDEPENDENCE BC
# 4
Identifier199073
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BCBS
# 5
Identifier30022409
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
Identifier3836033
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA HMO
# 7
Identifier927827 06
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: