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Individual

DR. MADGE ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1898 BRAEBURN DR, SALEM, VA 24153-7301
(540) 772-3008
(540) 772-3352
Mailing address
1898 BRAEBURN DR, SALEM, VA 24153-7301
(540) 772-3008
(540) 772-3352

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101229254
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007311974
VA
Enumeration date
12/28/2005
Last updated
11/12/2020
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