Provider Demographics
NPI:1285614578
Name:TINSLEY, ELLIS A JR (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:A
Last Name:TINSLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1717 SHIPYARD BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8019
Mailing Address - Country:US
Mailing Address - Phone:910-769-2583
Mailing Address - Fax:910-769-3531
Practice Address - Street 1:1717 SHIPYARD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8019
Practice Address - Country:US
Practice Address - Phone:910-769-2583
Practice Address - Fax:910-769-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2021-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC35569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983563Medicaid
NC8983563Medicaid
NC8983563Medicaid