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General NPI Number Information
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NPI Number | 1790815074
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Entity Type | Individual
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Provider Name | ELLEN MARIE MONGAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/28/2020
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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 | 410-938-5382
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Fax | 410-938-4806
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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 | 410-929-4617
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Fax | 855-234-9097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D0065840
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License Number State | MD
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