Individual
MICHAEL R ELLWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, PA-C
Contact information
Practice address
6030 SELWOOD PL, SPRINGFIELD, VA 22152-1412
(703) 569-1451
Mailing address
6030 SELWOOD PL, SPRINGFIELD, VA 22152-1412
(703) 569-1451
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000547
CT
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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