Individual
KERRI V ELLINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
659 S SALISBURY BLVD, SUITE 4, SALISBURY, MD 21801-5453
(410) 543-9111
(410) 543-9115
Mailing address
8110 MAPLE LAWN BLVD STE 235, FULTON, MD 20759-2694
(301) 340-8339
(301) 340-9027
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0002365
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
357675ZC6D
MEDICARE ID
MD
01
—
C0002365
STATE LICENSE
MD
Enumeration date
10/19/2007
Last updated
01/31/2019
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