Provider Demographics
NPI:1144472283
Name:MARY ELLEN PADUSI
Entity type:Organization
Organization Name:MARY ELLEN PADUSI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADUSI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-256-1006
Mailing Address - Street 1:4134 E JOPPA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2284
Mailing Address - Country:US
Mailing Address - Phone:410-256-1006
Mailing Address - Fax:410-256-0088
Practice Address - Street 1:4134 E JOPPA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD940691OtherEYEMED
MD613064-03OtherCAREFIRST/BLUE CROSS & BLUE SHIELD
MD210360-121OtherNVA
MD50070OtherDAVIS VISION
MD613064-02OtherCAREFIRST/BLUE CROSS&BLUE SHIELD
MD210360-121OtherNVA
MD613064-02OtherCAREFIRST/BLUE CROSS&BLUE SHIELD
MD50070OtherDAVIS VISION