Ellisen, Leif William
Ellisen, Leif William is an individual health care provider with primary practice located at 55 Fruit St Grj 904, Boston MA 02114-2696. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Medical Oncology. Allopathic & Osteopathic Physicians / Medical Oncology is his primary health care specialty. Ellisen, Leif William can be contacted via phone (617) 724-1399.Contact Information
Primary practice address
55 Fruit St Grj 904
Boston MA 02114-2696
Phone: (617) 724-1399
Fax: (617) 726-8623
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 79659 | Massachusetts |
| Allopathic & Osteopathic Physicians / Medical Oncology | 207RX0202X | 79659 | Massachusetts |
Profile Details
| NPI number | 1225028533 |
|---|---|
| LBN Legal business name | Ellisen, Leif William |
| Credentials | MD PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Oct 22nd, 2012 - about 14 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 | 1225028533 | NPPES |
| Massachusetts | Other | 079659 | TUFTS HEALTH PLAN |
| Massachusetts | Other | J19462 | TUFTS HEALTH PLAN |
| Massachusetts | MEDICAID | 3185338 | TUFTS HEALTH PLAN |
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