Individual
SUSANNAH G ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-2524
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(410) 933-7400
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01075059A
IN
2085R0001X
Radiation Oncology Physician
D0071963
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057572100
—
MD
05
—
201286120
—
IN
Enumeration date
02/16/2007
Last updated
03/15/2016
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