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General NPI Number Information
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NPI Number | 1841555398
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Entity Type | Individual
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Provider Name | CAROLYN ELLIS DO
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 498 ESSEX ST STE 106
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City | BANGOR
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State | ME
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Zip | 04401-3990
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Country | US
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Telephone | 207-942-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 498 ESSEX ST STE 106
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City | BANGOR
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State | ME
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Zip | 04401-3990
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Country | US
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Telephone | 207-942-0669
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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 | DO2591
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License Number State | ME
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