Provider Demographics
NPI:1518074228
Name:DURKIN, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:DURKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 MEETING HOUSE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2766
Mailing Address - Country:US
Mailing Address - Phone:978-250-4081
Mailing Address - Fax:978-250-3956
Practice Address - Street 1:4 MEETING HOUSE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2766
Practice Address - Country:US
Practice Address - Phone:978-250-4081
Practice Address - Fax:978-250-3956
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA124002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9978OtherBLUE CROSS BLUE SHIELD