Provider Demographics
NPI:1083804991
Name:DENNEHY, ELLEN (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:DENNEHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1413
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-1413
Mailing Address - Country:US
Mailing Address - Phone:508-240-0208
Mailing Address - Fax:508-240-0499
Practice Address - Street 1:27 NEW DURHAM RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-4917
Practice Address - Country:US
Practice Address - Phone:603-875-6151
Practice Address - Fax:603-875-2944
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2312363AM0700X
NH1250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT400375874OtherMEDICARE
NH3107960Medicaid