Active NPI
Mary Kottke Vincent, MPH, PA-C
- Medical Physician Assistant
- Takoma Park, MD
National Provider Identifier
1376668269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 555
- Practice address
- 6704 Cockerille Ave
Takoma Park, MD 20912-4730 - Phone
- (907) 957-2535
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 555 | AK | Primary |
Addresses
Primary practice location
6704 Cockerille Ave
Takoma Park, MD 20912-4730
Mailing address
6704 Cockerille Ave
Takoma Park, MD 20912-4730
Phone (907) 957-2535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 555 | AK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430697600000",
"number": "1376668269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6704 COCKERILLE AVE",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124730",
"telephone_number": "907-957-2535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6704 COCKERILLE AVE",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124730",
"telephone_number": "907-957-2535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINCENT",
"first_name": "MARY",
"middle_name": "KOTTKE",
"name_prefix": "Ms.",
"credential": "MPH, PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2015-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AK",
"license": "555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Takoma Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.