Provider Demographics
NPI:1821675307
Name:ELLIS, KAITLIN HATHAWAY (MD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:HATHAWAY
Last Name:ELLIS
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 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-809-6379
Mailing Address - Fax:508-342-1908
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-809-6379
Practice Address - Fax:508-342-1908
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP05444207V00000X
MA1024409207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology