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:
Health care specialties
| Specialty | Code | License # | 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 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 | 1407828486 | NPPES |
| Maryland | MEDICAID | 451601000 | |
| Maryland | MEDICAID | 101931175 | |
| Maryland | MEDICAID | 304010100 | |
| Maryland | Other | P00442458 |
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