Provider Demographics
NPI:1639626336
Name:CARDONI, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CARDONI
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 1:2718 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3595
Mailing Address - Country:US
Mailing Address - Phone:410-804-4257
Mailing Address - Fax:
Practice Address - Street 1:2718 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3595
Practice Address - Country:US
Practice Address - Phone:410-804-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN