MEDICARE: MS. MARY KATHRYN MACKANIN C.N.M.

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	367A00000X	Advanced Practice Midwife	AC001541	MD

General Provider Information

NPI Number	:	1154381143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KATHRYN MACKANIN C.N.M.

Provider Business Mailing Address
First Line	:	26005 RIDGE ROAD
Second Line	:	SUITE 200
City	:	DAMASCUS
State	:	MD
Zip	:	20872-1899
Country	:	US
Telephone Number	:	301-414-2300
Fax Number	:	301-414-2306

Provider Business Practice Location Address
First Line	:	26005 RIDGE ROAD
Second Line	:	SUITE 200
City	:	DAMASCUS
State	:	MD
Zip	:	20872-1899
Country	:	US
Telephone Number	:	301-414-2300
Fax Number	:	301-414-2306

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	09/16/2015

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