Healthcare Provider Details

I. General information

NPI: 1447604251
Provider Name (Legal Business Name): MARY KATHRYN LOCKHART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 ATLANTIC AVE
DELRAY BEACH FL
33484-8409
US

IV. Provider business mailing address

6140 ATLANTIC AVE
DELRAY BEACH FL
33484-8409
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-4407
  • Fax: 561-498-4480
Mailing address:
  • Phone: 561-498-4407
  • Fax: 561-498-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME176392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME176392
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME176392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: