Provider Demographics
NPI:1164423455
Name:GARDINER, MARY ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:GARDINER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:AAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:1509 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2742
Practice Address - Country:US
Practice Address - Phone:410-757-7600
Practice Address - Fax:410-626-8043
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9122236OtherAETNA PPO
MD687423-02OtherCAREFIRST MD RENDERING
MD120106OtherJHHC PROVIDER NUMBER
MD7605-0053OtherCAREFIRST BLUECHOICE
MD400109500Medicaid
MD500026827OtherRAILROAD MEDICARE
MD1978522OtherAETNA HMO
MD9122236OtherAETNA PPO
MD1978522OtherAETNA HMO