| Doctor Name: | MARWA ELLEBOUDY |
| NPI Number: | 1225457567 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BDS, LD |
| License Number: | |
| Business Practice Address: | 49 Harry Kemp Way Outer Cape Health Services, Inc. Provincetown, MA - 02657 |
| Business Phone Number: | 5084879395 |
| Business Fax Number: | 5084873285 |
| Mailing Address: | Po Box 1413, Outer Cape Health Services, Inc. WELLFLEET |
| State: | MA |
| Postal Code: | 02667 |
| Phone Number: | 5082400208 |
| Fax Number: | 5082400499 |
| NPI Enumeration Date: | 04/15/2014 |
| NPI Last Update Date: | 05/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |