Provider Demographics
NPI:1669440210
Name:GREGORY, MARIA E (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2858
Mailing Address - Country:US
Mailing Address - Phone:410-997-7979
Mailing Address - Fax:410-997-9231
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2858
Practice Address - Country:US
Practice Address - Phone:410-997-7979
Practice Address - Fax:410-997-9231
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC01085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS77997Medicare UPIN
MD930LE992Medicare ID - Type UnspecifiedMEDICARE
MD970028885Medicare ID - Type UnspecifiedRAILROAD MEDICARE