Individual
DR. ELLEN M MODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7320 216TH ST SW, SUITE 310, EDMONDS, WA 98026-8006
(425) 673-3800
Mailing address
7320 216TH ST SW, SUITE 310, EDMONDS, WA 98026-8006
(425) 673-3800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00031609
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130022930
RR MEDICARE
WA
05
—
8221814
—
WA
Enumeration date
07/12/2006
Last updated
05/13/2014
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