Provider Demographics
NPI:1598805178
Name:PANTAZIS, ELLA ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:ELIZABETH
Last Name:PANTAZIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1348
Mailing Address - Country:US
Mailing Address - Phone:301-773-4192
Mailing Address - Fax:
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:221
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-464-5813
Practice Address - Fax:301-464-5815
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD501937Medicare ID - Type Unspecified