MEDICARE: MRS. MARIA MERCEDES MEJIA-BOGDANSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	29938	MD
2	171M00000X	Case Manager/Care Coordinator	9611	MD

General Provider Information

NPI Number	:	1083162887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA MERCEDES MEJIA-BOGDANSKI

Provider Business Mailing Address
First Line	:	10226 BRADLEY LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3929
Country	:	US
Telephone Number	:	410-997-7022
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 E DIAMOND AVE STE E
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-5332
Country	:	US
Telephone Number	:	301-330-4359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	11/01/2016

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