Provider Demographics
NPI:1285000125
Name:MARY J KING DO PA
Entity Type:Organization
Organization Name:MARY J KING DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHONECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-581-4849
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:1B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-581-4849
Mailing Address - Fax:727-584-7429
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-585-7408
Practice Address - Fax:727-585-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty