Provider Demographics
NPI:1093245532
Name:MARDAGA, KAYLA (NP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MARDAGA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 SUE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1928
Mailing Address - Country:US
Mailing Address - Phone:410-980-2764
Mailing Address - Fax:
Practice Address - Street 1:1300 YORK RD STE 30D
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6090
Practice Address - Country:US
Practice Address - Phone:443-519-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily