Provider Demographics
NPI:1346612918
Name:MARY ANN WASHINGTON M.D.,P.A
Entity Type:Organization
Organization Name:MARY ANN WASHINGTON M.D.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-637-6320
Mailing Address - Street 1:5116 BISSONNET ST
Mailing Address - Street 2:SUITE 459
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4007
Mailing Address - Country:US
Mailing Address - Phone:713-637-6320
Mailing Address - Fax:713-637-0590
Practice Address - Street 1:1140 WESTMONT DR
Practice Address - Street 2:SUITE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4363
Practice Address - Country:US
Practice Address - Phone:713-637-6320
Practice Address - Fax:713-637-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0721207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124363602Medicaid
TX124363602Medicaid
TXWA08181J1Medicare PIN