Healthcare Provider Details

I. General information

NPI: 1447440060
Provider Name (Legal Business Name): ELLEN ADELIA DOEBLER PA-C, LRD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN ADELIA KAISER P.A

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 GERRARDSTOWN RD
INWOOD WV
25428-3450
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2888
US

V. Phone/Fax

Practice location:
  • Phone: 304-821-9011
  • Fax: 304-821-9012
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006335
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2064
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: