Provider Demographics
NPI:1144256223
Name:WEBER, ELLEN S (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051597022OtherBCBS
AL108898Medicaid
AL108904Medicaid
AL051527390OtherBLUECROSS BLUESHIELD AL
AL051597020OtherBCBS
AL108907Medicaid
ALP00829072OtherRAILRAOD MEDICARE
AL051597021OtherBCBS
AL510-05045OtherBC BS OF ALABAMA
AL009943008Medicaid
AL009990045Medicaid
AL051597022OtherBCBS
AL108907Medicaid
AL510I110407Medicare PIN
AL009990045Medicaid