Provider Demographics
NPI:1508353640
Name:ELLIS, CATHERINE ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:590 MANNING DR
Mailing Address - Street 2:CAMPUS BOX 7595
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7595
Mailing Address - Country:US
Mailing Address - Phone:984-974-4575
Mailing Address - Fax:919-843-9670
Practice Address - Street 1:590 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-2818
Practice Address - Country:US
Practice Address - Phone:984-974-4575
Practice Address - Fax:919-843-9670
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-00107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine