Individual
DR. KENNETH A ELLENBOGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 E MARSHALL ST, INTERNAL MEDICINE/CARDIOLOGY, RICHMOND, VA 23298-5051
(804) 828-7565
(804) 828-6082
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101040591
VA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
0101040591
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006027547
—
VA
Enumeration date
09/25/2006
Last updated
12/30/2022
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