Provider Demographics
NPI:1063631794
Name:MARY GEDA M D P A
Entity Type:Organization
Organization Name:MARY GEDA M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:WILMA
Authorized Official - Last Name:GEDA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:281-859-8855
Mailing Address - Street 1:4534 HIGHWAY 6 N # B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3402
Mailing Address - Country:US
Mailing Address - Phone:281-859-8855
Mailing Address - Fax:281-345-0732
Practice Address - Street 1:4534 HIGHWAY 6 N # B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3402
Practice Address - Country:US
Practice Address - Phone:281-859-8855
Practice Address - Fax:281-345-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty