Provider Demographics
NPI:1275635369
Name:SHOWSTARK, MARY E (PA C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:SHOWSTARK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:SHOWSTARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:27 W 23RD ST
Mailing Address - Street 2:PHYSICIAN ASSISTANT PROGRAM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4202
Mailing Address - Country:US
Mailing Address - Phone:212-463-0400
Mailing Address - Fax:
Practice Address - Street 1:27 W 23RD ST # 33
Practice Address - Street 2:PHYSICIAN ASSISTANT PROGRAM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4202
Practice Address - Country:US
Practice Address - Phone:212-463-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-284363AS0400X
CAPA18197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAMD-284OtherHI-LIC
CAPA18197OtherCA PA-C
NY014709-1OtherNYS
FLPA9102873OtherFL
CAPA18197OtherCA PA-C