Provider Demographics
NPI:1053317578
Name:DY, ELLEN ABLOG (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ABLOG
Last Name:DY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1035 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8104
Mailing Address - Country:US
Mailing Address - Phone:970-257-6902
Mailing Address - Fax:970-241-8443
Practice Address - Street 1:1035 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8104
Practice Address - Country:US
Practice Address - Phone:970-242-6600
Practice Address - Fax:970-241-8443
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058821207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0139659Medicaid
IAE88639Medicare UPIN
IA0139659Medicaid