Individual
ELLEN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(610) 209-6383
Mailing address
1610 CHRISTIAN ST APT 2, PHILADELPHIA, PA 19146-2066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA058639
PA
363AS0400X
Surgical Physician Assistant
MA058639
PA
Other
Enumeration date
08/22/2016
Last updated
01/26/2024
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