Provider Demographics
NPI:1578577391
Name:CZYMBOR-HEPBURN, MARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:CZYMBOR-HEPBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:CZYMBOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1783
Mailing Address - Country:US
Mailing Address - Phone:401-770-9546
Mailing Address - Fax:
Practice Address - Street 1:100 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-770-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4508778207R00000X
IN01079675B207R00000X
NJ25MA10218100207R00000X
MDD0085030207R00000X
DCMD045882207R00000X
MA79499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3130916Medicaid
MAJ30884Medicare ID - Type Unspecified
F93313Medicare UPIN