Provider Demographics
NPI:1003812421
Name:TSE, MARY M (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:TSE
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 1:136 SHERMAN AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5210
Mailing Address - Country:US
Mailing Address - Phone:203-776-7458
Mailing Address - Fax:203-776-2401
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:STE 301
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5210
Practice Address - Country:US
Practice Address - Phone:203-776-7458
Practice Address - Fax:203-776-2401
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-11-06
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CT22781207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C003189OtherCHAMPUS
CTP522300OtherOXFORD HEALTH PLAN
CT706941OtherCONNECTICARE
CT7110607-004OtherCIGNA
160010222OtherRAILROAD MEDICARE
CTOV0008OtherHEALTHNET
CT010022781CT02OtherANTHEM
CT706941OtherCONNECTICARE
CTD400065562Medicare PIN