Provider Demographics
NPI:1710407010
Name:BATTY, MARIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LYNN
Last Name:BATTY
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 1:12360 MANCHESTER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4302
Mailing Address - Country:US
Mailing Address - Phone:314-966-8500
Mailing Address - Fax:314-966-4499
Practice Address - Street 1:12360 MANCHESTER RD
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-4302
Practice Address - Country:US
Practice Address - Phone:314-966-8500
Practice Address - Fax:314-966-4499
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020015500208000000X, 2080P0204X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200061391Medicaid