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Individual

DR. ELLSWORTH J STAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1625 N GEORGE MASON DR, PATHOLOGY DEPT, ARLINGTON, VA 22205-3683
(703) 558-6541
(502) 456-4440
Mailing address
PO BOX 7308, ARLINGTON, VA 22207-0308
(800) 292-1387
(502) 456-4440

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101-029766
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006601782
VA
05
033007700
DC
01
1022-0004
CAREFIRST BLUE CROSS DC
DC
01
11-00210
UNITED HEALTHCARE
01
1305167
UNITED MINE WORKERS
01
16699
GEORGE WASHINGTON UNIV
01
220017496
RAILROAD MEDICARE
01
240523
ANTHEM BLUE CROSS BS
VA
01
339836
OPTIMUM CHOICE
01
490050CC62678
SECTION 1011 MEDICARE
01
506849
NATIONAL CAPITAL PPO
05
879500200
MD
01
96-2465316
WORKERS COMP DC
DC
Enumeration date
07/08/2006
Last updated
09/12/2011
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