Individual
MR. SCOTT C ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
789 CENTRAL AVE, DOVER, NH 03820-2526
(603) 740-2163
Mailing address
789 CENTRAL AVE, DOVER, NH 03820-2526
(603) 740-2163
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0315P
NH
363AM0700X
Medical Physician Assistant
PA-619
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242440099
—
ME
05
—
30330768
—
NH
Enumeration date
07/11/2006
Last updated
03/11/2019
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