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Individual

MS. MARY M MASTERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-0350
(410) 933-1390
Mailing address
PO BOX 64362, BALTIMORE, MD 21264-4362
(410) 550-0350
(410) 933-1390

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C01920
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C01920
LICENSE
MD
Enumeration date
05/11/2006
Last updated
10/19/2010
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