Individual
MS. MARY ELLEN CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6897
(410) 328-2109
Mailing address
PO BOX 64226, BALTIMORE, MD 21264-4742
(410) 328-6897
(410) 328-2109
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
R085542
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101
CAREFIRST REGIONAL
MD
01
—
64470401
BLUE SHIELD
MD
Enumeration date
07/27/2006
Last updated
02/04/2008
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