Provider Demographics
NPI:1467663971
Name:TAGLIAFERRI, MARY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:TAGLIAFERRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5858 HORTON ST STE 375
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2071
Mailing Address - Country:US
Mailing Address - Phone:510-420-4170
Mailing Address - Fax:510-601-5050
Practice Address - Street 1:5858 HORTON ST STE 375
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2071
Practice Address - Country:US
Practice Address - Phone:510-420-4170
Practice Address - Fax:510-601-5050
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85698208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice