Provider Demographics
NPI:1760668412
Name:CLEAVES-DUNCAN, MARY JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:CLEAVES-DUNCAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N BOND ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3533
Mailing Address - Country:US
Mailing Address - Phone:410-588-5999
Mailing Address - Fax:410-588-5877
Practice Address - Street 1:108 N BOND ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3533
Practice Address - Country:US
Practice Address - Phone:410-588-5999
Practice Address - Fax:410-588-5877
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1368PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD315086Medicare PIN