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General NPI Number Information
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NPI Number | 1548473150
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Entity Type | Individual
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Provider Name | CATHERINE JONNAKUTY ELLIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 19450 DEERFIELD AVENUE, SUITE 200
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City | LEESBURG
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State | VA
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Zip | 20176-6821
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Country | US
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Telephone | 703-844-8380
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Fax | 703-263-8393
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Provider Business Mailing Address
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Address Line | 224D CORNWALL ST NW STE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 571-291-9786
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MT189022
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0101259955
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License Number State | VA
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