Provider Demographics
NPI:1285814459
Name:GEORGE, MARY KUSUM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KUSUM
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9179 GRISSOM RD STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2811
Mailing Address - Country:US
Mailing Address - Phone:210-684-1020
Mailing Address - Fax:210-684-2434
Practice Address - Street 1:9179 GRISSOM RD STE 135
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2811
Practice Address - Country:US
Practice Address - Phone:210-684-1020
Practice Address - Fax:210-684-2434
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics