Provider Demographics
NPI:1821109000
Name:DAVIGLUS, MARY L (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:DAVIGLUS
Suffix:
Gender:F
Credentials:MD,PA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:ARDILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:3027 ZAHARIAS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7025
Mailing Address - Country:US
Mailing Address - Phone:407-240-6323
Mailing Address - Fax:407-240-6323
Practice Address - Street 1:3027 ZAHARIAS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7025
Practice Address - Country:US
Practice Address - Phone:407-240-6323
Practice Address - Fax:407-240-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40734207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53715OtherBLUE CROSS BLUE SHIELD
FL53715OtherUNITED HEALTHCARE
FL53715OtherBLUE CROSS BLUE SHIELD