Provider Demographics
NPI:1679521959
Name:DINITS-PENSY, MARA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:Y
Last Name:DINITS-PENSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARA
Other - Middle Name:YEFIM
Other - Last Name:DINITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5196
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5196
Practice Address - Fax:410-328-0248
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58875207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1679521959Medicaid
MD617979-01OtherBLUE CROSS/BLUE SHIELD
MD407737700Medicaid
MDI31741Medicare UPIN
MDL480Medicare PIN
MDP00608502Medicare PIN