Provider Demographics
NPI:1104986405
Name:ELLIS, RODNEY LANE (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:LANE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9811 GREENBELT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2215
Mailing Address - Country:US
Mailing Address - Phone:301-552-3953
Mailing Address - Fax:301-552-3957
Practice Address - Street 1:9811 GREENBELT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2215
Practice Address - Country:US
Practice Address - Phone:301-552-3953
Practice Address - Fax:301-552-3957
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-11-03
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Provider Licenses
StateLicense IDTaxonomies
MDD0021326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC62776Medicare UPIN
MDG01512R01Medicare PIN