Provider Demographics
NPI:1447238282
Name:CLANCE, MARY R (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:CLANCE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6469
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38328207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
6263782OtherAETNA HMO
S3990059OtherBCBS DC
53072411OtherBCBS MARYLAND
MD142441600Medicaid
5926262OtherAETNA PPO
181863ZADNMedicare PIN
P01072199Medicare PIN
181863Y5ZMedicare PIN
5926262OtherAETNA PPO
6263782OtherAETNA HMO
MD142441600Medicaid