Provider Demographics
NPI:1073177077
Name:LAM, ELLEN U (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:U
Last Name:LAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:C
Other - Last Name:UPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 RAY C HUNT DR STE 2100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2980
Practice Address - Country:US
Practice Address - Phone:434-924-1825
Practice Address - Fax:434-244-9456
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008955207RE0101X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism