Provider Demographics
NPI:1053847129
Name:AYRES, MARY MEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MEGAN
Last Name:AYRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MEGAN
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PSC 557 BOX 2393
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:676 FUTENMA
Practice Address - Street 2:
Practice Address - City:GINOWAN
Practice Address - State:OKINAWA
Practice Address - Zip Code:901-2202
Practice Address - Country:JP
Practice Address - Phone:703-802-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN0000065798208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program