Provider Demographics
NPI:1396768560
Name:FORD, ELEANOR YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:YVONNE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:344 UNIVERSITY BLVD W
Mailing Address - Street 2:# 321
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901
Mailing Address - Country:US
Mailing Address - Phone:301-681-4233
Mailing Address - Fax:301-681-4235
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:# 321
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-681-4233
Practice Address - Fax:301-681-4235
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD34589207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
112619Medicare ID - Type Unspecified
D83929Medicare UPIN