Provider Demographics
NPI:1306804869
Name:ELLIS, MILTON BARRY (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:BARRY
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S SOUTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4589
Mailing Address - Country:US
Mailing Address - Phone:336-673-3125
Mailing Address - Fax:336-838-9790
Practice Address - Street 1:708 S SOUTH ST STE 300
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4589
Practice Address - Country:US
Practice Address - Phone:336-838-7758
Practice Address - Fax:336-838-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38757208600000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00099783OtherRAILROAD MEDICARE
NC8930638Medicaid
NC8930638Medicaid
2147466AMedicare PIN