Basic Information
| Provider Information | |||||||||
| NPI: | 1285296913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURDA | ||||||||
| FirstName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17104 OLDE MILL RUN | ||||||||
| Address2: | |||||||||
| City: | DERWOOD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208551528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402055832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 DEFENSE HWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102669694 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363AM0700X | C07349 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | C07349 | 01 | MD | MARYLAND BOARD OF PHYSICIANS | OTHER |