Provider Demographics
NPI:1700857851
Name:ELLWOOD, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:ELLWOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2864 WOODRUFF STREET MCXC-PCS-BHC
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-570-3077
Mailing Address - Fax:910-643-4021
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:MCXP-CCS-CR
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-0417
Practice Address - Fax:573-596-0524
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-10-29
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Provider Licenses
StateLicense IDTaxonomies
VA0101232718208000000X
NC2018-02231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics