Healthcare Provider Details

I. General information

NPI: 1710054903
Provider Name (Legal Business Name): MARY ANN CRAIGHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 DUNMANWAY
DUNDALK MD
21222-5436
US

IV. Provider business mailing address

817 GLASS AVE
BALTIMORE MD
21221-5018
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-7182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR169260
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: