Provider Demographics
NPI:1710563671
Name:PATTON, ELLEN ANN GROSS
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANN GROSS
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:ANN
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1937 SWEDESFORD RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8733
Mailing Address - Country:US
Mailing Address - Phone:610-316-4956
Mailing Address - Fax:
Practice Address - Street 1:1937 SWEDESFORD RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8733
Practice Address - Country:US
Practice Address - Phone:610-316-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033380-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine