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General NPI Number Information
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NPI Number | 1770842874
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Entity Type | Individual
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Provider Name | COLIN ELLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 3400 CIVIC CENTER BOULEVARD 2ND FLOOR, SOUTH PAVILION
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 215-662-3606
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Fax | 215-243-2312
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE STREET 3 WEST GATES
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4206
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Country | US
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Telephone | 215-662-3606
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Fax | 215-243-2312
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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 | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | MD458436
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD458436
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License Number State | PA
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