Organization
NICHOLAS ELLYN, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS ELLYN M.D. (PHYSICIAN)
(703) 578-0100
Entity
Organization
Contact information
Practice address
4660 KENMORE AVE, SUITE 416, ALEXANDRIA, VA 22304-1313
(703) 751-0700
Mailing address
1707 OSAGE ST, SUITE 205, ALEXANDRIA, VA 22302-2607
(703) 578-0100
(703) 824-8357
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174626311
INDIVIDUAL NPI
—
05
—
6380883
—
VA
Enumeration date
03/10/2010
Last updated
03/10/2010
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