Provider Demographics
NPI:1942592548
Name:JOHNS, ELLIS BOISVERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:BOISVERT
Last Name:JOHNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 VALLEY HEALTH WAY # 300
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-6480
Mailing Address - Country:US
Mailing Address - Phone:540-631-3700
Mailing Address - Fax:
Practice Address - Street 1:351 VALLEY HEALTH WAY # 300
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-6480
Practice Address - Country:US
Practice Address - Phone:540-631-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine