Individual
ELLIE S KWAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-6757
Mailing address
2722 MERRILEE DR, STE 230, FAIRFAX, VA 22031-4400
(703) 698-4444
(703) 204-0116
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101265884
VA
2085R0202X
Diagnostic Radiology Physician
269509
MA
2085R0202X
Diagnostic Radiology Physician
D0087546
MD
Other
Enumeration date
07/10/2012
Last updated
02/04/2022
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