NPIMap

Individual provider Active NPI

Mary Alice S Shores, CRNP

  • Nurse Practitioner
  • Eldersburg, MD
National Provider Identifier
1922097161
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R124642 Issued in MD
Practice address
1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464
Phone
(410) 795-2233
Fax
(410) 795-3538
NPI assigned
Oct 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R124642 MD Primary

Addresses

Primary practice location

1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464

Mailing address

1380 Progress Way
Suite 114
Eldersburg, MD 21784-6464
Phone (410) 795-2233

Other identifiers 2

IdentifierTypeStateIssuer
124LOtherMDMEDICARE GROUP #-CARROLL PRIMARY CARE-124L
R124642OtherMDSTATE OF MD

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R124642MDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
Family Medical Center, LLC PastSince Jun 1, 2020 Accepting new patients
David B. Harding, MD Past Accepting new patients
Allergy & Asthma Center of Central Maryland, PA PastSince Jan 1, 1996 Accepting new patients
David B. Harding, MD Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1922097161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 PROGRESS WAY",
            "address_2": "SUITE 114",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846464",
            "telephone_number": "410-795-2233",
            "fax_number": "410-795-3538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 PROGRESS WAY",
            "address_2": "SUITE 114",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846464",
            "telephone_number": "410-795-2233",
            "fax_number": "410-795-3538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORES",
        "first_name": "MARY ALICE",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-20",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R124642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #-CARROLL PRIMARY CARE-124L",
            "identifier": "124L",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MD",
            "identifier": "R124642",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.