MEDICARE: MARTIE MCKENZIE VINSON

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	176B00000X	Midwife	DEM00051	MD

General Provider Information

NPI Number	:	1205706124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIE MCKENZIE VINSON

Provider Business Mailing Address
First Line	:	320 S HIGHLAND AVE APT 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2372
Country	:	US
Telephone Number	:	301-855-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5785
Country	:	US
Telephone Number	:	443-313-6017
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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Directions to “ MARTIE MCKENZIE VINSON ” Practice Location

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