Healthcare Provider Details

I. General information

NPI: 1871507210
Provider Name (Legal Business Name): MARGRETA MARY HELEN RATHBAUER CRNP, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YORK RD
TOWSON MD
21204-2516
US

IV. Provider business mailing address

6805 WELLWOOD CT
BALTIMORE MD
21209-1432
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-3900
  • Fax:
Mailing address:
  • Phone: 410-486-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR129781
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: