Provider Demographics
NPI:1043303068
Name:HEWITT, MARY FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FAYE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:F
Other - Last Name:HEWITT-LEVY (MARRIED)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 2115
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2115
Mailing Address - Country:US
Mailing Address - Phone:281-427-6363
Mailing Address - Fax:281-420-6867
Practice Address - Street 1:620 MASSEY TOMPKINS RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4312
Practice Address - Country:US
Practice Address - Phone:281-427-6363
Practice Address - Fax:281-838-8393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0925034-01Medicaid
TX2501903OtherAETNA
TX7285182OtherAETNA HMO
TX76-0662160OtherTAX IDENTIFICATION NUMBER
TX0047ENOtherBCBS
TX848422OtherHMO BLUE
TX2501903OtherAETNA
TX7285182OtherAETNA HMO