Provider Demographics
NPI:1265452171
Name:KINGSBURY, ELLEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:A
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2255
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-2255
Mailing Address - Country:US
Mailing Address - Phone:804-462-5155
Mailing Address - Fax:804-462-5922
Practice Address - Street 1:36 LIVELY OAKS ROAD
Practice Address - Street 2:
Practice Address - City:LIVELY
Practice Address - State:VA
Practice Address - Zip Code:22507
Practice Address - Country:US
Practice Address - Phone:804-462-5155
Practice Address - Fax:804-462-5922
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051241207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA323363OtherANTHEM BCBS
VA080108568OtherRR MEDICARE
VA080108568OtherRR MEDICARE
E28716Medicare UPIN