MEDICARE: DR. MARY THERESA SHEEHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D46410	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	543855-03	OTHER	MD	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1154361756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY THERESA SHEEHAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64442
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 S. GREENE STREET
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-0001
Country	:	US
Telephone Number	:	410-328-5196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	02/02/2009

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