| Doctor Name: | STEPHEN R ELLIN |
| NPI Number: | 1073532545 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD04990 |
| Business Practice Address: | 200 High Service Ave Radiology Department North Providence, RI - 029045113 |
| Business Phone Number: | 4014564215 |
| Business Fax Number: | 4014563019 |
| Mailing Address: | 21 Peace St, Suite 251 East PROVIDENCE |
| State: | RI |
| Postal Code: | 029071510 |
| Phone Number: | 4014564215 |
| Fax Number: | 4014563019 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 10/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | MD04990 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |