Healthcare Provider Details

I. General information

NPI: 1326213307
Provider Name (Legal Business Name): MARY KATHLEEN MCGAFFIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 BALTIMORE AVE SUITE 107
COLLEGE PARK MD
20740-3234
US

IV. Provider business mailing address

8763 REDONDO WAY
JESSUP MD
20794-9343
US

V. Phone/Fax

Practice location:
  • Phone: 301-864-2100
  • Fax: 301-864-5057
Mailing address:
  • Phone: 301-725-6868
  • Fax: 301-864-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR068203
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: