Individual provider · Type 1 NPI
Colette Mark Ellis, MD
General Practice Physician · Fairborn, OH
NPI number
1629530225
Active
Practice location
1059 Baywood Dr
Fairborn, OH 45324-2647
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgery Physician | 208600000X | S8030 (TX) |
| General Practice Physician Primary | 208D00000X | S8030 (TX) |
General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
About NPI 1629530225
Colette Mark Ellis, MD's National Provider Identifier is 1629530225, issued on Apr 2, 2019. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Fairborn, OH. The record was last updated on Jul 27, 2022.