Provider Demographics
NPI:1659390797
Name:MARKSTEIN, ELLEN A (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:A
Last Name:MARKSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 EAST MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2058
Mailing Address - Country:US
Mailing Address - Phone:860-669-6156
Mailing Address - Fax:860-664-0285
Practice Address - Street 1:8 EAST MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2058
Practice Address - Country:US
Practice Address - Phone:860-669-6156
Practice Address - Fax:860-664-0285
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT034247207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001342477Medicaid
G05931Medicare UPIN
CT001342477Medicaid