Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ellen Cannon

Individual provider Surgical Physician Assistant · NPI 1083169890

Ellen Cannon is a Physician Assistant in Philadelphia, Pennsylvania. Qualified in 2016, 10 years ago. Practices with Colorado Imaging Associates P C, a 61-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
10
Licensed in
PA
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone: (610) 209-6383
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 160 E Erie Ave, Philadelphia, PA 19134-1011 — (610) 209-6383

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence MA058639 (PA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence MA058639 (PA)

Record details

NPI number1083169890
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 22, 2016
Last updated in NPPESJanuary 26, 2024
Certification dateJanuary 26, 2024
Mailing address1610 Christian St Apt 2, Philadelphia, PA 19146-2066

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Colorado Imaging Associates P C — 61 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Philadelphia