Provider Demographics
NPI:1356750996
Name:MAYZEL, MARY (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MAYZEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MAYZEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:1455 ANDRE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5305
Mailing Address - Country:US
Mailing Address - Phone:703-447-5841
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE G50
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:443-573-1094
Practice Address - Fax:443-573-1097
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189238367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife