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1932171154

NPI Code Detail

MEDICARE: DR. JEFFREY B ELLIS MD

MEDICARE: DR. JEFFREY B ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD072036L	PA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD072036L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	232359401	OTHER	PA	MAIN LINE HEALTHCARE

General Provider Information

NPI Number	:	1932171154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY B ELLIS MD

Provider Business Mailing Address
First Line	:	1425 HORSHAM RD
Second Line	:	MEDICAL SUITE
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1320
Country	:	US
Telephone Number	:	215-815-7500
Fax Number	:	877-596-6460

Provider Business Practice Location Address
First Line	:	1425 HORSHAM RD
Second Line	:	MEDICAL SUITE
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1320
Country	:	US
Telephone Number	:	215-815-7500
Fax Number	:	877-596-6460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/15/2014

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Directions to “ DR. JEFFREY B ELLIS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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