Individual
DR. MARY C DECKELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
452 MARYLEBORN RD, SEVERNA PARK, MD 21146-1667
(216) 533-1713
Mailing address
452 MARYLEBORN RD, SEVERNA PARK, MD 21146-1667
(216) 533-1713
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
35082492
OH
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
D40684
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224470
UNISON
OH
01
—
000000532995
ANTHEM
OH
05
—
2431078
—
OH
01
—
363471
WELLCARE MEDICAID
OH
01
—
5140115
AETNA
OH
Enumeration date
07/15/2006
Last updated
07/21/2022
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