MEDICARE: CHRISTIANA G ELLISON PA-C

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	PA19496	TX

General Provider Information

NPI Number	:	1962373654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANA G ELLISON PA-C

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1842
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	713-790-2089
Fax Number	:	713-794-0576

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1842
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	713-790-2089
Fax Number	:	713-794-0576

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

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	10/05/2025

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