Provider Demographics
NPI:1235176157
Name:MCINERNEY, ELLEN ROSE (M D)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ROSE
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2787
Practice Address - Country:US
Practice Address - Phone:410-224-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000040572207R00000X
MDD70838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3338041Medicaid
TNH26254Medicare UPIN
TN3338041Medicaid