Provider Demographics
NPI:1881063774
Name:PFEIFER, MARY KATHRYN (CPNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHRYN
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 ALTAMONT PL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3023
Mailing Address - Country:US
Mailing Address - Phone:614-403-0974
Mailing Address - Fax:
Practice Address - Street 1:4255 ALTAMONT PL
Practice Address - Street 2:SUITE 301
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3023
Practice Address - Country:US
Practice Address - Phone:614-403-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218429363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics