Provider Demographics
NPI:1053752964
Name:HENRY, MARY BETH KASDA (MMS PA-C)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:KASDA
Last Name:HENRY
Suffix:
Gender:F
Credentials:MMS PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:KASDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS PA-C
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-7097
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant