Provider Demographics
NPI:1659619732
Name:ZAVADA, MARY CLARE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY CLARE
Middle Name:
Last Name:ZAVADA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2119
Mailing Address - Country:US
Mailing Address - Phone:443-852-4453
Mailing Address - Fax:
Practice Address - Street 1:1475 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2119
Practice Address - Country:US
Practice Address - Phone:443-852-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014657213E00000X
PASC006425213ES0103X
MD01546213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01725317OtherRAILROAD MEDICARE
MO1659619732Medicaid
MO149620009Medicare PIN
MO149630013Medicare PIN