Provider Demographics
NPI:1861441875
Name:DRYMALA, MARY KOEHNE (PAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KOEHNE
Last Name:DRYMALA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2021
Mailing Address - Country:US
Mailing Address - Phone:410-431-5125
Mailing Address - Fax:
Practice Address - Street 1:601 N.CAROLINE ST.
Practice Address - Street 2:PREOPERATIVE EVALUATION CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0712
Practice Address - Country:US
Practice Address - Phone:410-955-1553
Practice Address - Fax:410-614-8204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical