Provider Demographics
NPI:1558305722
Name:FRANK-TARSI, MARY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:FRANK-TARSI
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 1:1301 SUNSET DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4003
Mailing Address - Country:US
Mailing Address - Phone:662-229-0069
Mailing Address - Fax:662-229-0752
Practice Address - Street 1:1301 SUNSET DR
Practice Address - Street 2:SUITE E
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4003
Practice Address - Country:US
Practice Address - Phone:662-229-0069
Practice Address - Fax:662-229-0752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640713688OtherTAX IDENTIFICATION NUMBER
MS00123814Medicaid
MS640713688OtherTAX IDENTIFICATION NUMBER
MS00123814Medicaid
MS080003412Medicare PIN