Provider Demographics
NPI:1285861674
Name:ELLIS, LIXIA ZHAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LIXIA
Middle Name:ZHAO
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:LIXIA
Other - Middle Name:
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:802-447-5544
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5004
Practice Address - Country:US
Practice Address - Phone:802-447-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-3746207N00000X
VT042.0012576207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology