Kezia Lynnette Ellison, MD
Family Medicine in Hagerstown, MD. Individual provider (NPI-1).
NPI number1407412232
StatusActive
Last updated in NPPESJul 22, 2022
Details
- NPI
- 1407412232
- Entity type
- Individual (NPI-1)
- Name
- Kezia Lynnette Ellison
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 16, 2019
- Certification date
- Jul 22, 2022
- Last updated
- Jul 22, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | D094743 | MD | Yes |
Practice location
11110 Medical Campus Rd Ste 200Hagerstown, MD 21742-6797
Phone 301-790-9240
Mailing address
11110 Medical Campus Rd Ste 200Hagerstown, MD 21742-6797
Phone 301-790-9240
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