Dr Jonathan Mark Ellen, MD is a
Pediatrics physician based in St. Petersburg, Florida. Dr Jonathan Mark Ellen is licensed to practice in Florida (license number ME110221) and his current practice location is 501 6th Ave South, St. Petersburg, Florida. He can be reached at his office (for appointments etc.) via phone at
(727) 767-6873.
NPI number for Dr Jonathan Mark Ellen is 1871533547 and his current mailing address is 601 5th Street South, St. Petersburg, Florida. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1871533547.
Physician's Profile
| Full Name | Dr Jonathan Mark Ellen |
|---|
| Gender | Male |
|---|
| Speciality | Pediatrics |
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| Location | 501 6th Ave South, St. Petersburg, Florida |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1871533547
- Provider Enumeration Date: 06/08/2006
- Last Update Date: 12/29/2014
Medical Identifiers
Medical identifiers for Dr Jonathan Mark Ellen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1871533547 | NPI | - | NPPES |
| 472901300 | Medicaid | MD | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | D54679 (Maryland) | Secondary |
| 208000000X | Pediatrics | ME110221 (Florida) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jonathan Mark Ellen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| 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 |
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