Provider Demographics
NPI:1205965811
Name:MECH, CONSTANCE COOPER (PT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:COOPER
Last Name:MECH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 MAIDEN CHOICE LANE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3772
Mailing Address - Country:US
Mailing Address - Phone:410-247-1888
Mailing Address - Fax:410-247-1889
Practice Address - Street 1:817 MAIDEN CHOICE LANE
Practice Address - Street 2:SUITE 270
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3772
Practice Address - Country:US
Practice Address - Phone:410-247-1888
Practice Address - Fax:410-247-1889
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14182208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6902000000J532OtherBCBS
MD6902000000J532OtherBCBS