Provider Demographics
NPI:1154420008
Name:PHILIP S. ELLERIN, MD,PC
Entity type:Organization
Organization Name:PHILIP S. ELLERIN, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-272-7022
Mailing Address - Street 1:8 WILLIS LN
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1006
Mailing Address - Country:US
Mailing Address - Phone:781-334-4168
Mailing Address - Fax:
Practice Address - Street 1:172 CAMBRIDGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2984
Practice Address - Country:US
Practice Address - Phone:781-272-7022
Practice Address - Fax:781-272-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709176OtherGROUP TUFTS PROV #
MA=========OtherTAX ID #
MA709176OtherGROUP TUFTS PROV #
MA=========OtherTAX ID #