Healthcare Provider Details

I. General information

NPI: 1063048767
Provider Name (Legal Business Name): MARY-KATE C MEKHAIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY-KATE CRANE

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 38400 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

PSC 808 BOX 19
FPO AE
09618-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-694-9052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101274782
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: