Individual
MACKENZIE CARPENTER CERVENKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-9441
Mailing address
PO BOX 64227, BALTIMORE, MD 21264-4227
(410) 955-9441
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
D67856
MD
2084N0600X
Clinical Neurophysiology Physician
P18564
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326109300
—
MD
Enumeration date
02/21/2007
Last updated
02/05/2013
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