Provider Demographics
NPI:1558389163
Name:KING, MARY B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:B
Last Name:KING
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 1:710 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9316
Mailing Address - Country:US
Mailing Address - Phone:413-243-0122
Mailing Address - Fax:413-243-2251
Practice Address - Street 1:710 STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-9316
Practice Address - Country:US
Practice Address - Phone:413-243-0122
Practice Address - Fax:413-243-2251
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-04-12
Deactivation Date:2018-03-16
Deactivation Code:
Reactivation Date:2018-04-12
Provider Licenses
StateLicense IDTaxonomies
MA242278207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01758Medicare UPIN