Provider Demographics
NPI:1922400720
Name:UDSETH, MARY L (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:UDSETH
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-795-2233
Mailing Address - Fax:410-795-3538
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE 114
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6464
Practice Address - Country:US
Practice Address - Phone:410-795-2233
Practice Address - Fax:410-795-3538
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant