Individual
JOHN WESLEY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 HOSPITAL DRIVE, MARTINSBURG, WV 25401
(304) 264-1000
(304) 264-1374
Mailing address
PO BOX 1150, MARTINSBURG, WV 25402-1150
(304) 264-1000
(304) 264-1374
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16478
WV
207Q00000X
Family Medicine Physician
16478
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0052479000
—
MD
Enumeration date
07/12/2005
Last updated
03/30/2010
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