Ellsworth, Marc Andrew

Ellsworth, Marc Andrew is an individual health care provider with primary practice located at 3420 S Mercy Rd Ste 205 , Gilbert AZ 85297-0423. He recently has 3 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is his primary health care specialty. Ellsworth, Marc Andrew can be contacted via phone (602) 933-6345.

Contact Information

Primary practice address
3420 S Mercy Rd Ste 205 Gilbert AZ 85297-0423
Phone: (602) 933-6345
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 54096 Minnesota
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 51592 Arizona

Profile Details

NPI number 1609171115
LBN Legal business name Ellsworth, Marc Andrew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2011
Last updated Dec 9th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609171115 NPPES
Minnesota MEDICAID ENROLLED

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