Basic Information
| Provider Information | |||||||||
| NPI: | 1649266198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGARVEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3720 FARRAGUT AVENUE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208952110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019494242 | ||||||||
| FaxNumber: | 3019498041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 FARRAGUT AVENUE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208952110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019494242 | ||||||||
| FaxNumber: | 3019498041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RO64229 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | C0660004 | 01 | DC | BCBSNCA | OTHER |