Provider Demographics
NPI:1417984816
Name:WARD, MARILYN SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:SUE
Last Name:WARD
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 1:626 LAKEVIEW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3359
Mailing Address - Country:US
Mailing Address - Phone:727-449-8331
Mailing Address - Fax:727-446-1810
Practice Address - Street 1:626 LAKEVIEW RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3359
Practice Address - Country:US
Practice Address - Phone:727-449-8331
Practice Address - Fax:727-446-1810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1262232084F0202X, 2084P0800X, 2084P0805X
FLME895312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005623400Medicaid
F49380Medicare UPIN
FLEC641YMedicare PIN
CC3238Medicare PIN
FLEC641XMedicare PIN