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General NPI Number Information
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NPI Number | 1417949736
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Entity Type | Individual
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Provider Name | JAMES ANDREW ELLZY II M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 703-681-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 3214 10TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3510
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Country | US
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Telephone | 619-300-9639
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A064662
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0069949
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License Number State | MD
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