Provider Demographics
NPI:1083862445
Name:CARNELL, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:CARNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1616 FORT MYER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3110
Mailing Address - Country:US
Mailing Address - Phone:703-310-5179
Mailing Address - Fax:703-528-7474
Practice Address - Street 1:1616 FORT MYER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3110
Practice Address - Country:US
Practice Address - Phone:703-310-5179
Practice Address - Fax:703-528-7474
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDOO268632083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine