MARC ANDREW ELLSWORTH MD NPI 1609171115

NPI Information

NPI: 1609171115
Provider Name: MARC ANDREW ELLSWORTH, MD
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
3420 S MERCY RD STE 205
GILBERT, AZ
ZIP 85297
Phone: (602) 933-6345
Get Directions

Marc Andrew Ellsworth, MD is a neonatal-perinatal medicine pediatrics in Gilbert, AZ. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. Marc Andrew Ellsworth, MD NPI is 1609171115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3420 S MERCY RD STE 205
GILBERT, AZ
ZIP 85297-423
Phone: (602) 933-6345

The NPI 1609171115 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 1/13/2011 and was last updated on 12/9/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	208000000X	Pediatrics		54096	MINNESOTA	No
3	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	51592	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ENROLLED	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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