Provider Demographics
NPI:1386748747
Name:ELLIS, DAVID WILLIAMS (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAMS
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:PO BOX 116
Mailing Address - Street 2:192 W CENTER ST
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061
Mailing Address - Country:US
Mailing Address - Phone:717-692-4834
Mailing Address - Fax:717-692-3678
Practice Address - Street 1:192 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1314
Practice Address - Country:US
Practice Address - Phone:717-692-4834
Practice Address - Fax:717-692-3678
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026575E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAEL446512OtherHIGHMARK BLUE SHIELD
20009377OtherAMERIHEALTH MERCY
PA0009476790001Medicaid
1522001OtherGATEWAY
232364010OtherTRICARE
PA02725200OtherCAPITAL BLUE CROSS
110013871OtherRAILROAD MEDICARE
PAEL446512OtherHIGHMARK BLUE SHIELD
PA02725200OtherCAPITAL BLUE CROSS