Ellis, Vicki

Ellis, Vicki is an individual health care provider with primary practice located at 11116 Medical Campus Rd , Hagerstown MD 21742-6710. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Ellis, Vicki can be contacted via phone (240) 313-9580.

Contact Information

Primary practice address
11116 Medical Campus Rd Hagerstown MD 21742-6710
Phone: (240) 313-9580
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X D65453 Maryland
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD431001 Pennsylvania
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 19454 South Carolina

Profile Details

NPI number 1407828486
LBN Legal business name Ellis, Vicki
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 3rd, 2006
Last updated Jan 26th, 2024 - about 11 months 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407828486 NPPES
Maryland MEDICAID 451601000
Maryland MEDICAID 101931175
Maryland MEDICAID 304010100
Maryland Other P00442458

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