SUSANNAH G ELLSWORTH

INDIANAPOLIS, IN
NPI1336283951
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy2085R0001X 
(Licence: IN  01075059A)
Additional Taxonomies2085R0001X 
(Licence: MD  D0071963)
Enumeration Date2007-02-16
Last Update Date2016-03-15
Business Address
-- SUSANNAH G ELLSWORTH MD
550 UNIVERSITY BLVD
INDIANAPOLIS, IN 46202-5149
Phone number: 317-944-2524
Mailing Address
-- SUSANNAH G ELLSWORTH MD
250 N SHADELAND AVE SUITE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS, IN 46219-4959
Phone number: 410-933-7400
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