Individual
PHILIP S ELLERIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
29481
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-00053
UNITED HEALTHCARE
MA
01
—
1154420008
MEDICARE - GROUP
MA
01
—
4139
HARVARD PILGRIM HEALTH
MA
01
—
709176
TUFTS HEALTH PLAN
MA
01
—
B27122
BLUE CROSS BLUE SHIELD
MA
01
—
M12131
PTAN
MA
Enumeration date
10/16/2006
Last updated
06/18/2015
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