Provider Demographics
NPI:1841374261
Name:ONEILL, MARY MARGARET (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:ONEILL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:NAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2603 N WINCHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22213
Mailing Address - Country:US
Mailing Address - Phone:703-536-7702
Mailing Address - Fax:
Practice Address - Street 1:1801 METZEROTT ROAD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:301-434-0500
Practice Address - Fax:301-434-1962
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000300363L00000X
VA0024129639363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00297838OtherRR MEDICARE
P49423Medicare UPIN
VA019181H48Medicare ID - Type Unspecified