Provider Demographics
NPI:1750387247
Name:KITTS, ELLEN L (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:KITTS
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 1:1305 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5705
Mailing Address - Country:US
Mailing Address - Phone:304-242-1390
Mailing Address - Fax:304-243-5880
Practice Address - Street 1:1305 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5705
Practice Address - Country:US
Practice Address - Phone:304-242-1390
Practice Address - Fax:304-243-5880
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV138712081P0010X, 208100000X
OH35045295208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435318Medicaid
WV0112892000Medicaid
B40983Medicare UPIN
OH0435318Medicaid
WVKI0624782Medicare PIN