Provider Demographics
NPI:1730173717
Name:VUCICH, MARA (DO)
Entity type:Individual
Prefix:MRS
First Name:MARA
Middle Name:
Last Name:VUCICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ST PAUL PLACE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4600
Mailing Address - Country:US
Mailing Address - Phone:410-539-3434
Mailing Address - Fax:410-539-3550
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4600
Practice Address - Country:US
Practice Address - Phone:410-539-3434
Practice Address - Fax:410-539-3550
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00586721208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65518Medicare UPIN
709M26280Medicare ID - Type Unspecified