Provider Demographics
NPI:1073652004
Name:EWING, MARY MARGARET (MD, MBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:EWING
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 FAY AVE # 352
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0021
Mailing Address - Country:US
Mailing Address - Phone:619-549-4025
Mailing Address - Fax:
Practice Address - Street 1:1120 SILVERADO ST STE 203
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4524
Practice Address - Country:US
Practice Address - Phone:858-412-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2006-02202084P0800X
CAA1126992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry