Healthcare Provider Details

I. General information

NPI: 1881854834
Provider Name (Legal Business Name): ELLEN E IM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 N PALMER RD
BETHESDA MD
20889-5529
US

IV. Provider business mailing address

4494 N PALMER RD
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101246440
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101246440
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: