Provider Demographics
NPI:1023068657
Name:O'GARA, ELLEN MARIE TOWNLEY (NP)
Entity type:Individual
Prefix:
First Name:ELLEN MARIE
Middle Name:TOWNLEY
Last Name:O'GARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:TOWNLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5100 DORSET AVE
Mailing Address - Street 2:405
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5465
Mailing Address - Country:US
Mailing Address - Phone:202-486-8773
Mailing Address - Fax:
Practice Address - Street 1:7809 WISCONSIN AVE
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3523
Practice Address - Country:US
Practice Address - Phone:301-986-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN67863363L00000X
MDR115629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003103800Medicaid
DC025775300Medicaid
MD082NS476Medicare PIN
DCP26434Medicare UPIN
MD134796YRVMedicare PIN
MD003103800Medicaid