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General NPI Number Information
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NPI Number | 1285861674
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Entity Type | Individual
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Provider Name | LIXIA ZHAO ELLIS M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DR
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City | BENNINGTON
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State | VT
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Zip | 05201-5004
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Country | US
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Telephone | 802-447-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 140 HOSPITAL DR
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City | BENNINGTON
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State | VT
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Zip | 05201-5009
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Country | US
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Telephone | 802-447-5544
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | TL-3746
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 042.0012576
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License Number State | VT
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