Provider Demographics
NPI:1790860864
Name:ONEAL, ELLEN DEIRDRE (CNM)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:DEIRDRE
Last Name:ONEAL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 BELLS MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-530-3300
Mailing Address - Fax:301-530-7807
Practice Address - Street 1:6506 BELLS MILL ROAD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-3300
Practice Address - Fax:301-530-7807
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168463367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
64756001OtherCAREFIRST OF MARYLAND
C2030016OtherCAREFIRST BLUE CROSS BLUE