Provider Demographics
NPI:1508853086
Name:PRITCHETT, MARY ANN BUSCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:BUSCH
Last Name:PRITCHETT
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:PO BOX 430238
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1238
Mailing Address - Country:US
Mailing Address - Phone:205-977-7100
Mailing Address - Fax:205-502-7811
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-977-7100
Practice Address - Fax:205-502-7811
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025175207Q00000X
AL25175208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009944205Medicaid
AL009941415Medicaid
AL051554746Medicare PIN
ALH89048Medicare UPIN
ALI318Medicare PIN
AL009941415Medicaid