Provider Demographics
NPI:1316712623
Name:BROWN, MARY CATHLEEN (RDH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHLEEN
Other - Last Name:GALASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:134 COURSEVALL DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1824
Mailing Address - Country:US
Mailing Address - Phone:410-758-1224
Mailing Address - Fax:
Practice Address - Street 1:134 COURSEVALL DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1824
Practice Address - Country:US
Practice Address - Phone:410-758-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8358124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist