Provider Demographics
NPI:1144858507
Name:ELLENBERG, KERRY (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:ELLENBERG
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 1:1307 FEDERAL ST STE B201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4774
Mailing Address - Country:US
Mailing Address - Phone:412-578-1212
Mailing Address - Fax:412-605-6467
Practice Address - Street 1:1307 FEDERAL ST STE B201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4774
Practice Address - Country:US
Practice Address - Phone:412-578-1212
Practice Address - Fax:412-605-6467
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD486386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology