Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101241673 | VA |
N | 111NI0900X | Internist | 0101241673 | VA |
N | 207R00000X | Internist | 23152 | SC |
N | 111NI0900X | Internist | 23152 | SC |
Y | 2080P0202X | Pediatric Cardiologist | 0101241673 | VA |
N | 2080P0202X | Pediatric Cardiologist | 23152 | SC |
NPI | 1255421434 |
---|---|
Provider Name | Dr. Alexander Reed Ellis |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 13/04/2021 |