Individual
ELISE ELEANOR HILL FANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MPP
Contact information
Practice address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-3309
(215) 349-8310
(215) 893-7270
Mailing address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-3309
(215) 349-8310
(215) 893-7270
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
164482
CA
208600000X
Surgery Physician
Primary
MD489468
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2018
Last updated
07/17/2026
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