Dr Jonathan Mark Ellen, MD | |
501 6th Ave South, St. Petersburg, FL 33701 | |
(727) 767-6873 | |
Not Available |
Full Name | Dr Jonathan Mark Ellen |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 501 6th Ave South, St. Petersburg, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1871533547 | NPI | - | NPPES |
472901300 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | D54679 (Maryland) | Secondary |
208000000X | Pediatrics | ME110221 (Florida) | Primary |
Mailing Address | Practice Location Address |
---|---|
Dr Jonathan Mark Ellen, MD 601 5th Street South, St. Petersburg, FL 33701 Ph: (727) 767-6873 | Dr Jonathan Mark Ellen, MD 501 6th Ave South, St. Petersburg, FL 33701 Ph: (727) 767-6873 |
Jacquelyn Faryn Crews, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 501 6th Ave South, St. Petersburg, FL 33701 Phone: 727-767-4106 Fax: 727-767-8804 | |
Dr. Samrat V Ambewadikar, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 10051 5th St N, Suite 200, St. Petersburg, FL 33702 Phone: 727-824-0780 Fax: 813-514-8891 |