Provider Demographics
NPI:1437158920
Name:LIUZZA, ELLEN F (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:F
Last Name:LIUZZA
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 1:100 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6471
Mailing Address - Country:US
Mailing Address - Phone:865-482-1777
Mailing Address - Fax:865-482-1030
Practice Address - Street 1:100 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6471
Practice Address - Country:US
Practice Address - Phone:865-482-1777
Practice Address - Fax:865-482-1030
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50024216OtherPASSPORT
TNQ017377Medicaid
KY000000613609OtherANTHEM
KYP00754793OtherRAILROAD MEDICARE
KY3718940000OtherPASSPORT ADVANTAGE
KY7100083480Medicaid
KY3718940000OtherPASSPORT ADVANTAGE
KY7100083480Medicaid