Healthcare Provider Details

I. General information

NPI: 1962638288
Provider Name (Legal Business Name): MARYLAND PAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BUILDING 10 CRC 6-5340 MSC 1276
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DRIVE BUILDING 10 CRC 6-5340 MSC 1276
BETHESDA MD
20892-1276
US

V. Phone/Fax

Practice location:
  • Phone: 301-435-5770
  • Fax: 301-402-2588
Mailing address:
  • Phone: 301-435-5770
  • Fax: 301-402-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD37259
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD37259
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberD37259
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: