Healthcare Provider Details

I. General information

NPI: 1891321857
Provider Name (Legal Business Name): ELLEN ANN SOCKMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WESTOVER TER STE 201
GREENSBORO NC
27408-7131
US

IV. Provider business mailing address

2205 LANCE RIDGE CT
WINSTON SALEM NC
27127-7606
US

V. Phone/Fax

Practice location:
  • Phone: 336-373-0611
  • Fax:
Mailing address:
  • Phone: 239-209-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025-00194
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2025-00194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: