Provider Demographics
NPI:1134411044
Name:NGO, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5801
Mailing Address - Country:US
Mailing Address - Phone:972-867-7777
Mailing Address - Fax:972-519-1679
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5801
Practice Address - Country:US
Practice Address - Phone:972-867-7777
Practice Address - Fax:972-519-1679
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ3067207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344364001Medicaid
TX344364001Medicaid