Provider Demographics
NPI:1629065479
Name:JANARIOUS, MARY K (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:JANARIOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 WEST OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6614
Mailing Address - Country:US
Mailing Address - Phone:407-846-3455
Mailing Address - Fax:407-846-3670
Practice Address - Street 1:801 WEST OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6614
Practice Address - Country:US
Practice Address - Phone:407-846-3455
Practice Address - Fax:407-846-3670
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME41498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067299800Medicaid
FL067299800Medicaid