Provider Demographics
NPI:1083615355
Name:MCCLURE, KAREN LOUISE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:BORZILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:800 COOL GLADE CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1731
Mailing Address - Country:US
Mailing Address - Phone:410-987-0784
Mailing Address - Fax:410-987-0784
Practice Address - Street 1:484 RITCHIE HWY # A
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2911
Practice Address - Country:US
Practice Address - Phone:410-544-4600
Practice Address - Fax:410-544-0997
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR066214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7605-0074OtherCAREFIRST BLUECHOICE
MD646351-01OtherCAREFIRST MD RENDERING
MD116724OtherJHHC PROVIDER NUMBER
MD116724OtherJHHC PROVIDER NUMBER
MDQ50849Medicare UPIN