Provider Demographics
NPI:1679766000
Name:STETTMEIER, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:STETTMEIER
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 1:4759 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4945
Mailing Address - Country:US
Mailing Address - Phone:727-841-8772
Mailing Address - Fax:727-848-5897
Practice Address - Street 1:4759 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-841-8772
Practice Address - Fax:727-848-5897
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196360207Q00000X
NH17660207Q00000X
VA0101255972207Q00000X
NH61-47192083A0300X
FLME137555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VAC05704OtherGROUP PTAN
VAC06778OtherGROUP PTAN
VAC06695OtherGROUP PTAN