Frederick R Ellwanger III, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

18944 Issued in NC

Practice address

749 Wild Oak LN NW
Calabash, NC 28467-1939

Phone

(910) 575-7678

Fax

(910) 575-7678

NPI assigned

Sep 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Laura Jacimore, PA

  • Radiation Oncology Physician
  • Rocky Mount, NC
  • NPI 1306020912
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043319098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 WILD OAK LN NW",
            "city": "CALABASH",
            "state": "NC",
            "postal_code": "284671939",
            "telephone_number": "910-575-7678",
            "fax_number": "910-575-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 WILD OAK LN NW",
            "city": "CALABASH",
            "state": "NC",
            "postal_code": "284671939",
            "telephone_number": "910-575-7678",
            "fax_number": "910-575-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLWANGER",
        "first_name": "FREDERICK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NC",
            "license": "18944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Wemyss Danford, PHARM.D.
• Deeb & Fanning DDS PA
• David Philip Deeb, DDS
• Desired Changes, PLLC
• Janenne E Ellis, PT
• Empowher Health Services
• Michael John Fanning, DDS
• Forever Yours, Inc
• Ganglani Calabash PLLC (Deeb & Fanning, DDS, PA)
• Hannah Gaskins, FNP-C

• Radiation Oncology Physician in Calabash, NC
• Providers in Calabash, NC by specialty
• Radiation Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.