Provider Demographics
NPI:1649266198
Name:MCGARVEY, MARY A (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:MCGARVEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 FARRAGUT AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2110
Mailing Address - Country:US
Mailing Address - Phone:301-949-4242
Mailing Address - Fax:301-949-8041
Practice Address - Street 1:3720 FARRAGUT AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2110
Practice Address - Country:US
Practice Address - Phone:301-949-4242
Practice Address - Fax:301-949-8041
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO64229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC0660004OtherBCBSNCA
S78074Medicare UPIN
DC003054A88Medicare PIN