Provider Demographics
NPI:1275584807
Name:ZAGREBELSKY, ELLEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:N
Last Name:ZAGREBELSKY
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 1:9892 BUSTLETON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2184
Mailing Address - Country:US
Mailing Address - Phone:267-672-2281
Mailing Address - Fax:267-672-8243
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2184
Practice Address - Country:US
Practice Address - Phone:267-672-2281
Practice Address - Fax:267-672-8243
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074148L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH55305Medicare UPIN
PA055099Medicare ID - Type Unspecified