Provider Demographics
NPI:1558610949
Name:MUSSMAN, MARY GENETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GENETTE
Last Name:MUSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W PRESTON ST.
Mailing Address - Street 2:ROOM 523
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-767-5468
Mailing Address - Fax:410-333-7687
Practice Address - Street 1:201 W PRESTON ST
Practice Address - Street 2:ROOM 523
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-767-4139
Practice Address - Fax:410-333-7687
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0032362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics