Provider Demographics
NPI:1578787966
Name:AMOS, MARY CATHERINE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:AMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 COMMERCE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2565
Mailing Address - Country:US
Mailing Address - Phone:410-459-3210
Mailing Address - Fax:410-638-6790
Practice Address - Street 1:2217 COMMERCE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2565
Practice Address - Country:US
Practice Address - Phone:410-459-3210
Practice Address - Fax:410-638-6790
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK361-0001OtherCAREFIRST BCBS