Ellis, Keith Lawrence
Ellis, Keith Lawrence is an individual health care provider with primary practice located at 46 Albion St , Bridgeport CT 06605-2602. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as his primary health care specialty. Ellis, Keith Lawrence can be contacted via phone (203) 330-6000.Contact Information
Primary practice address
46 Albion St
Bridgeport CT 06605-2602
Phone: (203) 330-6000
Fax: (203) 330-6008
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 5501 | Connecticut |
Profile Details
| NPI number | 1144654666 |
|---|---|
| LBN Legal business name | Ellis, Keith Lawrence |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 3rd, 2013 |
| Last updated | Sep 12th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144654666 | NPPES |
| Connecticut | MEDICAID | 004236136 |
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