Healthcare Provider Details

I. General information

NPI: 1528431020
Provider Name (Legal Business Name): MARY KATHLEEN HABER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY KATHLEEN LYNCH

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PARK AVE STE 200
BALTIMORE MD
21201-5634
US

IV. Provider business mailing address

2140 PEACHTREE RD NW STE 232
ATLANTA GA
30309-1316
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-0300
  • Fax: 443-738-0301
Mailing address:
  • Phone: 404-231-4431
  • Fax: 404-231-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR195767
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-46806
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR195767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: