Individual
ELLEN T. GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44084 RIVERSIDE PARKWAY, SUITE 300, LEESBURG, VA 20176-5102
(703) 724-7530
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110-004631
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437564911
—
VA
05
—
30016466390003
—
VA
Enumeration date
06/24/2014
Last updated
10/18/2023
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