Provider Demographics
NPI:1427166131
Name:ELLISON, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:ELLISON
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 1:65 PENNSYLVANIA AVE
Mailing Address - Street 2:ORTHOPEDIC ASSOCIATES
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-723-5393
Mailing Address - Fax:607-771-0803
Practice Address - Street 1:65 PENNSYLVANIA AVE
Practice Address - Street 2:ORTHOPEDIC ASSOCIATES
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-723-5393
Practice Address - Fax:607-771-0803
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162071207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350114Medicaid
34739JMedicare ID - Type Unspecified
F19653Medicare UPIN