Healthcare Provider Details

I. General information

NPI: 1396035549
Provider Name (Legal Business Name): SUSAN S ELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-6500
  • Fax: 202-660-6501
Mailing address:
  • Phone: 410-933-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1041966
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR224377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: