Provider Demographics
NPI:1790720001
Name:EMSELLEM, HELENE AUDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:HELENE
Middle Name:AUDREY
Last Name:EMSELLEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10300 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1835
Mailing Address - Country:US
Mailing Address - Phone:301-509-0069
Mailing Address - Fax:301-654-5658
Practice Address - Street 1:10300 GLEN RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1835
Practice Address - Country:US
Practice Address - Phone:301-654-1575
Practice Address - Fax:301-654-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00263992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366861400Medicaid
B94347Medicare UPIN