Provider Demographics
NPI:1184945776
Name:CARSON, MARY L (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:CARSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3656
Mailing Address - Country:US
Mailing Address - Phone:410-696-2890
Mailing Address - Fax:410-696-2886
Practice Address - Street 1:3290 N RIDGE RD STE 125
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3656
Practice Address - Country:US
Practice Address - Phone:410-696-2890
Practice Address - Fax:410-696-2886
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01197231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist