Provider Demographics
NPI:1407276728
Name:ELLIS, MARGARET A
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 S ATHERTON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8324
Mailing Address - Country:US
Mailing Address - Phone:814-466-7921
Mailing Address - Fax:814-466-6570
Practice Address - Street 1:3901 S ATHERTON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-7921
Practice Address - Fax:814-466-6570
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant