Provider Demographics
NPI:1881824522
Name:BLAIR, ELLEN KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:KAY
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7808 SENTER FARM RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9788
Mailing Address - Country:US
Mailing Address - Phone:919-773-9010
Mailing Address - Fax:
Practice Address - Street 1:1390 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1118
Practice Address - Country:US
Practice Address - Phone:919-256-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00079207R00000X
VA0101046579207R00000X
PAMD033736E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine