Provider Demographics
NPI:1699746784
Name:ELLIS, PETER G (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-7706
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:200 DELAFIELD RD
Practice Address - Street 2:SUITE 3050
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3205
Practice Address - Country:US
Practice Address - Phone:412-781-3744
Practice Address - Fax:412-781-3793
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2013-12-06
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Provider Licenses
StateLicense IDTaxonomies
PAMD037207E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11178651OtherCAQH
OH2571159Medicaid
PA001197107Medicaid
PA001197107Medicaid
OH2571159Medicaid