Provider Demographics
NPI:1619067816
Name:ELLERIN, PHILIP S (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:ELLERIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:172 CAMBRIDGE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-272-7022
Mailing Address - Fax:781-272-8786
Practice Address - Street 1:172 CAMBRIDGE STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-7022
Practice Address - Fax:781-272-8786
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA29481207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA03-00053OtherUNITED HEALTHCARE
MA4139OtherHARVARD PILGRIM HEALTH
MA709176OtherTUFTS HEALTH PLAN
MAB27122OtherBLUE CROSS BLUE SHIELD
MAM12131OtherPTAN
MA1154420008OtherMEDICARE - GROUP
MA03-00053OtherUNITED HEALTHCARE
MA709176OtherTUFTS HEALTH PLAN