Provider Demographics
NPI:1285693697
Name:RIFINO, MARY R (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:RIFINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 MEADOW RIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6458
Mailing Address - Country:US
Mailing Address - Phone:667-234-8650
Mailing Address - Fax:667-234-8655
Practice Address - Street 1:6518 MEADOW RIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6458
Practice Address - Country:US
Practice Address - Phone:667-234-8650
Practice Address - Fax:667-234-8655
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD759331700Medicaid
MD0022OtherCAREFIRST-DC
MD0022OtherCAREFIRST-DC
MD526400-02OtherCAREFIRST-MD
MD759331700Medicaid