Provider Demographics
NPI:1285624353
Name:RAY, ELLEN M (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:242 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1336
Mailing Address - Country:US
Mailing Address - Phone:978-630-6280
Mailing Address - Fax:978-630-6592
Practice Address - Street 1:242 GREEN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1336
Practice Address - Country:US
Practice Address - Phone:978-630-6280
Practice Address - Fax:978-630-6592
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59976207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D87923Medicare UPIN
MAJ0810001Medicare UPIN