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:
Health care specialties
Specialty | Code | License # | 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 5 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 | 1609171115 | NPPES |
Minnesota | MEDICAID | ENROLLED |
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