Provider Demographics
NPI:1154497675
Name:OGRADY, MARY ELIZABETH (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:OGRADY
Suffix:
Gender:F
Credentials:RPAC
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Mailing Address - Street 1:11 GRACE AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-2882
Mailing Address - Fax:516-482-6039
Practice Address - Street 1:11 GRACE AVENUE
Practice Address - Street 2:SUITE 100 BODIAN DERMATOLOGY GROUP PC
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-2882
Practice Address - Fax:516-482-6039
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0062671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P16465Medicare UPIN