Healthcare Provider Details

I. General information

NPI: 1528009891
Provider Name (Legal Business Name): ELLEN L DE GROOF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW GEORGETOWN UNIVERSITY HOSPITAL
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

9717 BEMAN WOODS WAY
POTOMAC MD
20854-5460
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-6680
  • Fax:
Mailing address:
  • Phone: 301-767-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD036406
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: