Active NPI
Carl Ellenberger Jr., MD
- Neurology Physician
- Mt Gretna, PA
National Provider Identifier
1023255536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- G 18787
- Practice address
- 96 Birch Ave
Mount Gretna, PA 17064-0070 - Phone
- (717) 964-3885
- Fax
- (717) 964-3885
- NPI assigned
- Jan 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | G 18787 | CA | Primary |
Addresses
Primary practice location
96 Birch Ave
Mount Gretna, PA 17064-0070
Mailing address
PO Box 70
96 Birch Av
Mount Gretna, PA 17064-0070
Phone (717) 964-3885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G 18787 | CA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1023255536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70",
"address_2": "96 BIRCH AV",
"city": "MOUNT GRETNA",
"state": "PA",
"postal_code": "170640070",
"telephone_number": "717-964-3885",
"fax_number": "717-964-3885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 BIRCH AVE",
"city": "MOUNT GRETNA",
"state": "PA",
"postal_code": "170640070",
"telephone_number": "717-964-3885",
"fax_number": "717-964-3885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENBERGER",
"first_name": "CARL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-21",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "G 18787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Gretna, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.