Provider Demographics
NPI:1447440060
Name:DOEBLER, ELLEN ADELIA (PA-C, LRD, CDE)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ADELIA
Last Name:DOEBLER
Suffix:
Gender:F
Credentials:PA-C, LRD, CDE
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ADELIA
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:4803 GERRARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3450
Practice Address - Country:US
Practice Address - Phone:304-821-9011
Practice Address - Fax:304-821-9012
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006335363A00000X
WV2064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND712779Medicare PIN