Individual
KIMBERLY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 HITCHCOCK WAY, MANCHESTER, NH 03104-4125
(603) 308-1467
Mailing address
PO BOX 810, HANOVER, NH 03755-0810
(603) 308-1467
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23152
NH
208600000X
Surgery Physician
A173760
CA
2086X0206X
Surgical Oncology Physician
A173760
CA
Other
Enumeration date
06/22/2016
Last updated
10/03/2022
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