Provider Demographics
NPI:1235388174
Name:FLOETER, MARY KAY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY KAY
Middle Name:
Last Name:FLOETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE MSC 1404
Mailing Address - Street 2:BLD 10 ROOM 7-5680
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1404
Mailing Address - Country:US
Mailing Address - Phone:301-496-7428
Mailing Address - Fax:301-402-8796
Practice Address - Street 1:10 CENTER DRIVE MSC 1404
Practice Address - Street 2:BLD 10 ROOM 7-5680
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1404
Practice Address - Country:US
Practice Address - Phone:301-496-7428
Practice Address - Fax:301-402-8796
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD401382084N0400X
CAG0588252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology