Provider Demographics
NPI:1942294491
Name:ANDERSON, MARY F (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:QUINN PAVILLION 3RD FLOOR
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2102
Mailing Address - Fax:617-789-3477
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:QUINN PAVILLION 3RD FLOOR
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2102
Practice Address - Fax:617-789-3477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA746832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3114228Medicaid
MA3114228Medicaid
MAJ14186Medicare ID - Type Unspecified