Provider Demographics
NPI:1265585483
Name:MUSSENDEN, CARYL GLENDA (MD)
Entity type:Individual
Prefix:
First Name:CARYL
Middle Name:GLENDA
Last Name:MUSSENDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 GREENBELT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2215
Mailing Address - Country:US
Mailing Address - Phone:301-552-1111
Mailing Address - Fax:301-552-9555
Practice Address - Street 1:9811 GREENBELT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2215
Practice Address - Country:US
Practice Address - Phone:301-552-1111
Practice Address - Fax:301-552-9555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019555207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01857Medicare ID - Type Unspecified
MDY27217Medicare UPIN