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Individual
MARK I ELLEN
Active
Individual
MARK I ELLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME145025
FL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
2005-01826
NC
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
25MA06361300
NJ
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
50578
GA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
G71376
CA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
MD051555L
PA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
ME145025
FL
Other
Enumeration date
09/06/2006
Last updated
05/18/2020
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