Provider Demographics
NPI:1952378044
Name:BELLAIRS, ELLEN E (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:BELLAIRS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1127
Mailing Address - Country:US
Mailing Address - Phone:651-779-7978
Mailing Address - Fax:651-779-7656
Practice Address - Street 1:1580 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1127
Practice Address - Country:US
Practice Address - Phone:651-779-7978
Practice Address - Fax:651-779-7656
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN392982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP34893OtherHEALTHPARTNERS
MN1241604OtherAMERICA'S PPO
MN151583OtherUCARE MN
MN084K3BEOtherBCBS MN
WI34065500Medicaid
MN1027080OtherPREFERRED ONE
MN2400114OtherMEDICA
MN412702100Medicaid
MN920000233Medicare ID - Type UnspecifiedMEDICARE
MN2400114OtherMEDICA
MN1241604OtherAMERICA'S PPO