Provider Demographics
NPI:1265483119
Name:JOYCE, ELLEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARIE
Last Name:JOYCE
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:PO BOX 99176
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269-0176
Mailing Address - Country:US
Mailing Address - Phone:502-499-6189
Mailing Address - Fax:502-499-0538
Practice Address - Street 1:3500 GOOD SAMARITAN WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6117
Practice Address - Country:US
Practice Address - Phone:502-267-7403
Practice Address - Fax:502-267-8978
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64198419Medicaid
KY64198419Medicaid
KY0705701Medicare PIN