Provider Demographics
NPI:1205101995
Name:PEART, MARIA DELORES (PASTOR/DO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DELORES
Last Name:PEART
Suffix:
Gender:F
Credentials:PASTOR/DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 FREETOWN RD
Mailing Address - Street 2:SUITE 200#77
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4016
Mailing Address - Country:US
Mailing Address - Phone:410-660-9378
Mailing Address - Fax:
Practice Address - Street 1:6470 FREETOWN RD
Practice Address - Street 2:SUITE200#77
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4016
Practice Address - Country:US
Practice Address - Phone:410-660-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MD78468999374K00000X
MD374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner