Provider Demographics
NPI:1063509784
Name:ELLINGTON, DAVID A (M D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2356
Mailing Address - Country:US
Mailing Address - Phone:540-463-9158
Mailing Address - Fax:540-463-4218
Practice Address - Street 1:146 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2356
Practice Address - Country:US
Practice Address - Phone:540-463-9158
Practice Address - Fax:540-463-4218
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5667461Medicaid
VA5667461Medicaid