Individual
LISA L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1250 E MARSHALL ST, OB/GYN, RICHMOND, VA 23298-5051
(804) 560-8950
(804) 560-7343
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101234748
VA
207R00000X
Internal Medicine Physician
5468
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6004870
—
SD
Enumeration date
06/16/2005
Last updated
02/26/2010
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