Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 158067 | NY |
Y | 208000000X | Pediatrician | 9953 | SC |
NPI | 1003984857 |
---|---|
Provider Name | Beverly Turner Ellington |
First Address | Greenville, SC 29615-4545 |
Second Address | Easley, SC 29640-2144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 18/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099538 | (05) | SC |
102463DL | PREFERRED CARE (01) | NY |
1147117 | (05) | NY |
158067CP | WORKER'S COMP (01) | NY |
2697340 | GHI (01) | NY |
A72790 | (02) | NY |
P010158067 | BLUE CHOICE (01) | NY |
P010158067 | BLUE SHIELD (01) | NY |