Provider Demographics
NPI:1235308750
Name:CARDIN, MARY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:CARDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LINKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1154
Mailing Address - Country:US
Mailing Address - Phone:912-634-8418
Mailing Address - Fax:912-634-0749
Practice Address - Street 1:157 LINKSIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1154
Practice Address - Country:US
Practice Address - Phone:912-634-8418
Practice Address - Fax:912-634-0749
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010497207QA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39547Medicare UPIN