Individual
DR. VICKI ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
(240) 313-9580
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19454
SC
207Q00000X
Family Medicine Physician
D65453
MD
207Q00000X
Family Medicine Physician
Primary
MD431001
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101931175
—
PA
05
—
304010100
—
MD
05
—
451601000
—
MD
01
—
P00442458
RAILROAD
MD
Enumeration date
02/03/2006
Last updated
01/26/2024
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