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General NPI Number Information
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NPI Number | 1255421434
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Entity Type | Individual
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Provider Name | ALEXANDER REED ELLIS M.D., M.SC.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 601 CHILDRENS LN CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS
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City | NORFOLK
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State | VA
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Zip | 23507-1910
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Country | US
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Telephone | 757-668-7214
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Fax | 757-668-8225
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Provider Business Mailing Address
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Address Line | 601 CHILDRENS LANE, 2ND FLOOR, CARDIOLOGY CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS
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City | NORFOLK
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State | VA
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Zip | 23507-1910
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Country | US
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Telephone | 757-668-7213
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Fax | 757-668-8225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101241673
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23152
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number | 0101241673
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 23152
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101241673
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License Number State | VA
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