Provider Demographics
NPI:1134462641
Name:ELLISON, JOEL BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BENJAMIN
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STETSON ST STE 3200
Mailing Address - Street 2:PO BOX 670559
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0559
Mailing Address - Country:US
Mailing Address - Phone:513-558-5100
Mailing Address - Fax:
Practice Address - Street 1:260 STETSON ST STE 3200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0559
Practice Address - Country:US
Practice Address - Phone:513-558-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.0232052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program