Provider Demographics
NPI:1053471581
Name:HENNESSEY, ANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:621 S NEW BALLAS RD STE 1001B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8264
Mailing Address - Country:US
Mailing Address - Phone:314-872-8752
Mailing Address - Fax:314-872-3963
Practice Address - Street 1:621 S NEW BALLAS RD STE 1001B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8264
Practice Address - Country:US
Practice Address - Phone:314-872-8752
Practice Address - Fax:314-872-3963
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH02505Medicare UPIN