Provider Demographics
NPI:1942296124
Name:MCAVOY, MARCIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:A
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:22 S GREENE ST
Mailing Address - Street 2:DEPT. OF RADIOLOGY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3477
Mailing Address - Fax:410-328-2115
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3477
Practice Address - Fax:410-328-2115
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00328492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70576Medicare UPIN
MDH380X506Medicare PIN
MD865L198EMedicare PIN