MEDICARE: ELLEN MCEWEN 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	207Q00000X	Family Medicine Physician	G67506	CA

General Provider Information

NPI Number	:	1972570190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MCEWEN MD

Provider Business Mailing Address
First Line	:	245 WASHINGTON ST
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-2409
Country	:	US
Telephone Number	:	831-372-2273
Fax Number	:	831-372-5840

Provider Business Practice Location Address
First Line	:	245 WASHINGTON ST
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-2409
Country	:	US
Telephone Number	:	831-372-2273
Fax Number	:	831-372-5840

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	05/16/2012

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