Provider Demographics
NPI:1053435784
Name:OFOSU, ELLEN K
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:K
Last Name:OFOSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 APPLEGRATH WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5608
Mailing Address - Country:US
Mailing Address - Phone:240-388-6593
Mailing Address - Fax:240-477-4737
Practice Address - Street 1:11408 APPLEGRATH WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-5608
Practice Address - Country:US
Practice Address - Phone:240-388-6593
Practice Address - Fax:240-477-4737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL03713747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant