=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871484600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY PINKARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 BROADWAY RD
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-615-1288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1386
-----------------------------------------------------
City | BROOKLANDVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21022-1386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-561-8498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------