Individual
MATTHEW J. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 DUKE MEDICINE CIR, DURHAM, NC 27710-4000
(919) 684-8111
Mailing address
PO BOX 63362, CHARLOTTE, NC 28263-3362
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200600873
NC
207RN0300X
Nephrology Physician
Primary
200600873
NC
208M00000X
Hospitalist Physician
200600873
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143RY
BCBS
NC
05
—
5905092
—
NC
Enumeration date
09/25/2006
Last updated
05/14/2014
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