Individual
MARC ANDREW ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3420 S MERCY RD STE 205, GILBERT, AZ 85297-0423
(602) 933-6345
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
54096
MN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
51592
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
01/13/2011
Last updated
12/09/2020
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