Provider Demographics
NPI:1831379122
Name:WIEGNER, ELLEN A (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:A
Last Name:WIEGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2948
Mailing Address - Fax:916-858-7065
Practice Address - Street 1:3301 C STREET
Practice Address - Street 2:SUITE 550
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-536-3200
Practice Address - Fax:916-235-2182
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
CAA1052332085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology