Individual
MARY JANE FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4351 NORTHVIEW DRIVE, BOWIE, MD 20716-2602
(301) 464-1893
(301) 464-1824
Mailing address
16317 BAWTY CT, BOWIE, MD 20715
(301) 464-2581
(301) 464-1824
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14890
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512984 01
CAREFIRST
MD
01
—
S891 0001
CAREFIRST
—
Enumeration date
11/27/2006
Last updated
02/22/2008
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