Provider Demographics
NPI:1639415268
Name:TARAWALEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TARAWALEY
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 1:9114 EDMONSTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1516
Mailing Address - Country:US
Mailing Address - Phone:240-701-1631
Mailing Address - Fax:
Practice Address - Street 1:9114 EDMONSTON CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1516
Practice Address - Country:US
Practice Address - Phone:240-701-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide