Provider Demographics
NPI:1790105088
Name:ELLINGSON, ALEXANDRA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 FRANCE AVE S STE W400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2165
Mailing Address - Country:US
Mailing Address - Phone:952-920-2730
Mailing Address - Fax:952-567-7092
Practice Address - Street 1:6405 FRANCE AVE S STE W400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-920-2730
Practice Address - Fax:952-567-7092
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN63879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty