Provider Demographics
NPI:1548224983
Name:ELLISON, SEAN ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALFRED
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 211
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1232
Practice Address - Country:US
Practice Address - Phone:336-832-3088
Practice Address - Fax:336-832-3080
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501233207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60902OtherMEDCOST
NC5423138OtherAETNA
NC12317OtherPARTNERS MEDICARE
NC8930469Medicaid
NC30469OtherBCBS NC
NC8930469Medicaid
NC5423138OtherAETNA