Healthcare Provider Details

I. General information

NPI: 1760456388
Provider Name (Legal Business Name): MARY JO KAHLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 NEW HAMPSHIRE AVE SUITE 201
SILVER SPRING MD
20903-1400
US

IV. Provider business mailing address

10230 NEW HAMPSHIRE AVE SUITE 201
SILVER SPRING MD
20903-1400
US

V. Phone/Fax

Practice location:
  • Phone: 301-651-4374
  • Fax: 301-439-4299
Mailing address:
  • Phone: 301-651-4374
  • Fax: 301-439-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR034548CS-P
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier821101900
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: