Healthcare Provider Details

I. General information

NPI: 1841244571
Provider Name (Legal Business Name): MARY PATRICIA OLIN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

7221 PANORAMA DR
DERWOOD MD
20855-1940
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2350
  • Fax: 202-741-2791
Mailing address:
  • Phone: 301-840-9692
  • Fax: 202-741-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberDCPA215
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: