Provider Demographics
NPI:1407850241
Name:COX, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:COX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:21 HIGHLAND AVE SE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2218
Mailing Address - Country:US
Mailing Address - Phone:540-344-9213
Mailing Address - Fax:540-345-7559
Practice Address - Street 1:21 HIGHLAND AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2218
Practice Address - Country:US
Practice Address - Phone:540-344-9213
Practice Address - Fax:540-345-7559
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54088505616OtherJOHN DEERE
VA268898OtherANTHEM
VA010022916Medicaid
VA6421077OtherCIGNA
VA7062419OtherAETNA
VA080228419OtherSOUTHERN HEALTH
VA2166024OtherMAMSI
VA2166024OtherMAMSI