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General NPI Number Information
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NPI Number | 1821468349
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Entity Type | Individual
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Provider Name | DAQUANE ELLINGTON MS, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 09/26/2015
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Last Update Date | 09/26/2015
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Provider Practice Location Address
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Address Line | 1700 E COLD SPRING LN
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City | BALTIMORE
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State | MD
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Zip | 21251-0001
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Country | US
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Telephone | 443-885-3486
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SUGARLOAF CT APT 101
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City | BALTIMORE
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State | MD
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Zip | 21209-2325
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A00747
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | J3-0000516
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License Number State | DE
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