Provider Demographics
NPI:1225072747
Name:ELLIS, CHRISTINA E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2547
Mailing Address - Country:US
Mailing Address - Phone:610-903-6200
Mailing Address - Fax:610-429-1057
Practice Address - Street 1:728 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2547
Practice Address - Country:US
Practice Address - Phone:610-903-6200
Practice Address - Fax:610-429-1057
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035003E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1301335OtherCIGNA
PA0011279710007Medicaid
0091952000OtherINDEPENDENCE BC
199073OtherHIGHMARK BCBS
PA30022409Medicaid
3836033OtherAETNA HMO
927827 06OtherUNITED HEALTHCARE
PA199073Medicare ID - Type Unspecified
927827 06OtherUNITED HEALTHCARE