Individual
DR. LEIF WILLIAM ELLISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
55 FRUIT ST, GRJ 904, BOSTON, MA 02114-2696
(617) 724-1399
(617) 726-8623
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-6500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
79659
MA
207RX0202X
Medical Oncology Physician
Primary
79659
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079659
TUFTS HEALTH PLAN
MA
05
—
3185338
—
MA
01
—
J19462
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
10/22/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us