Provider Demographics
NPI:1316017726
Name:ELLISON, JULIUS (MD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ASHBOURNE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2502
Mailing Address - Country:US
Mailing Address - Phone:215-635-2737
Mailing Address - Fax:215-782-8692
Practice Address - Street 1:404 ASHBOURNE ROAD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2502
Practice Address - Country:US
Practice Address - Phone:215-635-2737
Practice Address - Fax:215-782-8692
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006115E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C27233Medicare UPIN