Provider Demographics
NPI:1598983900
Name:COGAR, MARY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:COGAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-880-2540
Mailing Address - Fax:410-825-0310
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-880-2540
Practice Address - Fax:410-825-0310
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2807103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCO88Medicare ID - Type Unspecified