Provider Demographics
NPI:1316935455
Name:DARCY, MARY HELEN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:DARCY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-395-6000
Mailing Address - Fax:781-395-4703
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 217
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-395-6000
Practice Address - Fax:781-395-4703
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154282363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353621Medicaid
P04332Medicare UPIN
MANP2358Medicare ID - Type Unspecified