Provider Demographics
NPI:1770842874
Name:ELLIS, COLIN (MD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:3 WEST GATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3606
Mailing Address - Fax:215-243-2312
Practice Address - Street 1:3400 CIVIC CENTER BOULEVARD
Practice Address - Street 2:2ND FLOOR, SOUTH PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-3606
Practice Address - Fax:215-243-2312
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2025-06-13
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Provider Licenses
StateLicense IDTaxonomies
PAMD4584362084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology