Provider Demographics
NPI:1942359625
Name:MINER, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4877 MISSION ST
Mailing Address - Street 2:4877 MISSION ST.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3413
Mailing Address - Country:US
Mailing Address - Phone:415-405-0222
Mailing Address - Fax:415-405-0223
Practice Address - Street 1:256 BAY VISTA CIR
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1037
Practice Address - Country:US
Practice Address - Phone:415-887-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46316207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF16198Medicare UPIN