Provider Demographics
NPI:1184609778
Name:GOLODNER, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:GOLODNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61425 DAVIS LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1955
Mailing Address - Country:US
Mailing Address - Phone:541-848-7360
Mailing Address - Fax:
Practice Address - Street 1:61425 DAVIS LAKE LOOP
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1955
Practice Address - Country:US
Practice Address - Phone:541-848-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26954207RG0100X
WI48989-020207RG0100X
NMMD2006-0056207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF37055Medicare UPIN