1992764815 NPI number — MARY L FLEURY M.D.

Table of content: MARY L FLEURY M.D. (NPI 1992764815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992764815 NPI number — MARY L FLEURY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEURY
Provider First Name:
MARY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992764815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 10TH ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
POCOMOKE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21851-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-957-3005
Provider Business Mailing Address Fax Number:
410-957-0550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
POCOMOKE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21851-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-957-3005
Provider Business Practice Location Address Fax Number:
410-957-0550
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D24871 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 852693 . This is a "MAMSI PROVIDER NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41361804 . This is a "PROVIDER NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 114099 . This is a "ANTHEM PROVIDER NO." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 111724 . This is a "COVENTRY PROVIDER NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F094 0002 . This is a "PROVIDER NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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