Provider Demographics
NPI:1740587708
Name:MOFFATT, ELLEN GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:GRACE
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:850 BRYANT ST
Mailing Address - Street 2:HALL OF JUSTICE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4603
Mailing Address - Country:US
Mailing Address - Phone:415-553-1796
Mailing Address - Fax:415-553-1640
Practice Address - Street 1:850 BRYANT ST
Practice Address - Street 2:HALL OF JUSTICE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4603
Practice Address - Country:US
Practice Address - Phone:415-553-1796
Practice Address - Fax:415-553-1640
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
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Provider Licenses
StateLicense IDTaxonomies
CAA66146207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology