Provider Demographics
NPI:1407823297
Name:FIELD, ELLEN MERYL
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MERYL
Last Name:FIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:FIELD
Other - Last Name:RUBBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-868-8435
Practice Address - Street 1:1665 VALLEY CENTER PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-868-8460
Practice Address - Fax:610-868-8435
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026798E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35223Medicare UPIN
081864Medicare ID - Type Unspecified