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1619971421

NPI Code Detail

MEDICARE: MARY LYNNE MCDOUGLE CRNA

MEDICARE: MARY LYNNE MCDOUGLE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	AC000388	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F232 0013	OTHER	DC	BCBS
2	68639503	OTHER	MD	BCBS MD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619971421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LYNNE MCDOUGLE CRNA

Provider Business Mailing Address
First Line	:	PO BOX 120
Second Line	:	202 MAPLE AVE STE B
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-0120
Country	:	US
Telephone Number	:	410-810-7055
Fax Number	:	410-810-7054

Provider Business Practice Location Address
First Line	:	100 BROWN ST
Second Line	:
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-1435
Country	:	US
Telephone Number	:	410-778-3300
Fax Number	:	410-810-7180

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/05/2007

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Directions to “ MARY LYNNE MCDOUGLE CRNA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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