Provider Demographics
NPI:1053522060
Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE
Entity type:Organization
Organization Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOLLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-847-4247
Mailing Address - Street 1:2333 ONTARIO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2627
Mailing Address - Country:US
Mailing Address - Phone:202-420-3000
Mailing Address - Fax:
Practice Address - Street 1:3912 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5861
Practice Address - Country:US
Practice Address - Phone:202-420-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037536500Medicaid
MD410505200Medicaid
DC037564900OtherOTHER PRACTICE LOCATION