Provider Demographics
NPI:1588279897
Name:MPI, MARY CHINEDU
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHINEDU
Last Name:MPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 FORMAN CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-5607
Mailing Address - Country:US
Mailing Address - Phone:301-404-6560
Mailing Address - Fax:
Practice Address - Street 1:2187 FORMAN CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-5607
Practice Address - Country:US
Practice Address - Phone:301-404-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR16266101YM0800X
DCNP1005434363LP0808X
MDR162669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health