Healthcare Provider Details

I. General information

NPI: 1770140535
Provider Name (Legal Business Name): MARY ELIZABETH REED SHENK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ELIZABETH REED

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LANDMARK DR STE 217-219
GLEN BURNIE MD
21061-4987
US

IV. Provider business mailing address

PO BOX 64445
BALTIMORE MD
21264-4445
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-1324
  • Fax: 410-766-4177
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0102958
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0102958
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2020013973
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: