Provider Demographics
NPI:1497108930
Name:MCGINNIS, ELLYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:
Other - Last Name:MAYHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 GLASSWORKS RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:PA
Practice Address - Zip Code:15338-9507
Practice Address - Country:US
Practice Address - Phone:724-943-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA058272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical