Provider Demographics
NPI:1831853712
Name:BEARD, ELLERY ANNE
Entity type:Individual
Prefix:
First Name:ELLERY
Middle Name:ANNE
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 BRICKERT CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9633
Mailing Address - Country:US
Mailing Address - Phone:317-292-2992
Mailing Address - Fax:
Practice Address - Street 1:533 E COUNTY LINE RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1074
Practice Address - Country:US
Practice Address - Phone:317-497-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPENDING207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology