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Individual

KEITH ANTHONY ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
R.T.(R)(CT)(ARRT)

Contact information

Practice address
711 COURT ST, PORTSMOUTH, VA 23704-3625
(757) 648-9284
Mailing address
711 COURT ST, PORTSMOUTH, VA 23704-3625
(757) 648-9284

Taxonomy

Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
Primary
256008

Other

Enumeration date
09/12/2022
Last updated
09/12/2022
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