MEDICARE: MARY CHINEDU MPI

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	101YM0800X	Mental Health Counselor	R16266	MD
2	101YM0800X	Mental Health Counselor	R162669	MD
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP1005434	DC

General Provider Information

NPI Number	:	1588279897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHINEDU MPI

Provider Business Mailing Address
First Line	:	2187 FORMAN CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-5607
Country	:	US
Telephone Number	:	301-404-6560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2187 FORMAN CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-5607
Country	:	US
Telephone Number	:	301-404-6560
Fax Number	:

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

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	08/12/2025

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