Provider Demographics
NPI:1326096991
Name:PALMER, MARY EMERY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EMERY
Last Name:PALMER
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 1:315 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3813
Mailing Address - Country:US
Mailing Address - Phone:703-683-1884
Mailing Address - Fax:
Practice Address - Street 1:225 N FAIRFAX ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2646
Practice Address - Country:US
Practice Address - Phone:703-647-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063721207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00047820OtherRRMCR
VA010009171Medicaid
VA012190E00Medicare ID - Type Unspecified
VA010009171Medicaid