Provider Demographics
NPI:1578556064
Name:MCGINN, ELIZABETH B (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:MCGINN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2352
Mailing Address - Country:US
Mailing Address - Phone:410-828-5558
Mailing Address - Fax:410-823-6315
Practice Address - Street 1:8625 PLEASANT PLAINS RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2352
Practice Address - Country:US
Practice Address - Phone:410-828-5558
Practice Address - Fax:410-823-6315
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD864200100Medicaid
MD864200100Medicaid
469EMedicare ID - Type Unspecified