Provider Demographics
NPI:1255463741
Name:MCCOURT-SKEBERDIS, KARA (NCTMB)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:
Last Name:MCCOURT-SKEBERDIS
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MILLERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:COOKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21723-9404
Mailing Address - Country:US
Mailing Address - Phone:443-745-0406
Mailing Address - Fax:
Practice Address - Street 1:5016 DORSEY HALL DR
Practice Address - Street 2:STE. 102
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7823
Practice Address - Country:US
Practice Address - Phone:410-997-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist