Healthcare Provider Details

I. General information

NPI: 1437718699
Provider Name (Legal Business Name): MADELINE EL-GHOUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SILVERSIDE ST
IJAMSVILLE MD
21754-9173
US

IV. Provider business mailing address

10260 SILVERSIDE ST
IJAMSVILLE MD
21754-9173
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR206385
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR206385
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: