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General NPI Number Information
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NPI Number | 1346872157
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Entity Type | Organization
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Legal Business Name | DR ELLEN M MONGAN MD PA
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 6701 N CHARLES ST STE 4104
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City | BALTIMORE
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State | MD
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Zip | 21204-6808
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Country | US
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Telephone | 410-929-4617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5391
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City | BALTIMORE
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State | MD
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Zip | 21209-0391
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLEN MARIE MONGAN
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Credential | MD
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Telephone | 410-929-4617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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