Provider Demographics
NPI:1144310418
Name:PADUSI, MARY ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:PADUSI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BEACON POINT CT
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4533
Mailing Address - Country:US
Mailing Address - Phone:410-679-5922
Mailing Address - Fax:
Practice Address - Street 1:4134 E JOPPA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2284
Practice Address - Country:US
Practice Address - Phone:410-256-1006
Practice Address - Fax:410-256-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0922152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD613064-03OtherCAREFIRST-BLUE CROSS BLUE SHIELD
MD210360-121OtherNVA
MD50070OtherDAVIS VISION
MD613064-02OtherCAREFIRST/ BLUE CROSS/BLU
MD940691OtherEYEMED
MD828RMedicare ID - Type Unspecified
MD613064-03OtherCAREFIRST-BLUE CROSS BLUE SHIELD