Healthcare Provider Details

I. General information

NPI: 1558610949
Provider Name (Legal Business Name): MARY GENETTE MUSSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PRESTON ST ROOM 523
BALTIMORE MD
21201
US

IV. Provider business mailing address

201 W PRESTON ST. ROOM 523
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-767-4139
  • Fax: 410-333-7687
Mailing address:
  • Phone: 410-767-5468
  • Fax: 410-333-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0032362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: