Provider Demographics
NPI:1750303798
Name:WERZ, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:WERZ
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 1:700 S PARK ST STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:608-260-3447
Practice Address - Street 1:700 S PARK ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:608-260-3447
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66714-0202084N0400X, 2084N0400X
IA383032084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750303798Medicaid
OH740603OtherBUCKEYE MEDICAID
130009080OtherMCR RR
OHWE0752231Medicare PIN
OH652176OtherAETNA
IAI0923183Medicare PIN
IAP00756223Medicare UPIN
OH364125OtherWELLCARE MEDICAID
OHP00402011OtherMEDICARE RAILROAD
OH000000221030OtherUNISON
OH000000510689OtherANTHEM
F71000Medicare UPIN
OH0953277Medicaid
OHWE4059378Medicare PIN