Provider Demographics
NPI:1891835534
Name:ALAVI, MARY M (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:ALAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:ALAVI-SERESHKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16125 CAIRNWAY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3556
Mailing Address - Country:US
Mailing Address - Phone:281-855-2273
Mailing Address - Fax:281-855-0710
Practice Address - Street 1:16125 CAIRNWAY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3556
Practice Address - Country:US
Practice Address - Phone:281-855-2273
Practice Address - Fax:281-855-0710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD83783Medicare UPIN
TX8F1589Medicare ID - Type Unspecified