Provider Demographics
NPI:1275612160
Name:DEFLORA, ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:DEFLORA
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 1:5 BAY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-453-0235
Mailing Address - Fax:
Practice Address - Street 1:3124 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-782-0021
Practice Address - Fax:919-571-0825
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1252688OtherUNITED HEALTHCARE
NC60890OtherMEDCOST
NC7409331OtherAETNA
NC116725OtherWELLPATH
NC2748521OtherCIGNA
NC27789OtherBCBS OF NC
NC8927789Medicaid