1326213307 NPI number — MS. MARY KATHLEEN MCGAFFIN CRNP

Table of content: MS. MARY KATHLEEN MCGAFFIN CRNP (NPI 1326213307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326213307 NPI number — MS. MARY KATHLEEN MCGAFFIN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGAFFIN
Provider First Name:
MARY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326213307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8763 REDONDO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JESSUP
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20794-9343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-725-6868
Provider Business Mailing Address Fax Number:
301-864-5057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7305 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20740-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-864-2100
Provider Business Practice Location Address Fax Number:
301-864-5057
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  R068203 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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