Provider Demographics
NPI:1245239938
Name:PALEN, ELLEN MARYE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARYE
Last Name:PALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2367 COLONY CROSSING PLACE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-323-1264
Mailing Address - Fax:804-323-1276
Practice Address - Street 1:2367 COLONY CROSSING PLACE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-323-1264
Practice Address - Fax:804-323-1276
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA236600OtherANTHEM BCBS
VA10331382Medicaid
VA10331382Medicaid
VA236600OtherANTHEM BCBS