Provider Demographics
NPI:1386768612
Name:ELLIS, HERMAN MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:MARTIN
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9123 OLD ANNAPOLIS RD STE 203&204
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1953
Mailing Address - Country:US
Mailing Address - Phone:410-505-8605
Mailing Address - Fax:240-770-0436
Practice Address - Street 1:100 BIDDLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3982
Practice Address - Country:US
Practice Address - Phone:410-505-8605
Practice Address - Fax:240-770-0436
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-00074342083P0901X
DEC100074342083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine