Ellis, Madge
Ellis, Madge is an individual health care provider with primary practice located at 1898 Braeburn Dr , Salem VA 24153-7301. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Ellis, Madge can be contacted via phone (540) 772-3008.Contact Information
Primary practice address
1898 Braeburn Dr
Salem VA 24153-7301
Phone: (540) 772-3008
Fax: (540) 772-3352
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 0101229254 | Virginia |
Profile Details
| NPI number | 1619954948 |
|---|---|
| LBN Legal business name | Ellis, Madge |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2005 |
| Last updated | Nov 12th, 2020 - about 4 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 | 1619954948 | NPPES |
| Virginia | MEDICAID | 007311974 |
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