Provider Demographics
NPI:1033109343
Name:ASHUR, MARY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:ASHUR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:88 WHARF ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3429
Mailing Address - Country:US
Mailing Address - Phone:617-696-7601
Mailing Address - Fax:671-696-2138
Practice Address - Street 1:88 WHARF ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3429
Practice Address - Country:US
Practice Address - Phone:617-696-7601
Practice Address - Fax:671-696-2138
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3066967Medicaid
MAJ10014Medicare ID - Type Unspecified
MA3066967Medicaid