Healthcare Provider Details

I. General information

NPI: 1245453489
Provider Name (Legal Business Name): NANCY J. MAGONE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16036 FREDERICK RD
WOODBINE MD
21797-8524
US

IV. Provider business mailing address

16036 FREDERICK RD
WOODBINE MD
21797-8524
US

V. Phone/Fax

Practice location:
  • Phone: 410-489-4890
  • Fax: 410-489-4890
Mailing address:
  • Phone: 410-489-4890
  • Fax: 410-489-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11420
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: