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Individual
SUSAN ELIZABETH ELLINGTON
Active
Individual
SUSAN ELIZABETH ELLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J5154
TX
208000000X
Pediatrics Physician
Primary
J5154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043581003
—
TX
05
—
043581004
—
TX
05
—
200564510 A
—
OK
05
—
90458303
—
NM
Enumeration date
01/09/2014
Last updated
09/09/2020
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