Provider Demographics
NPI:1962460220
Name:ANDERSON, MARY ESSEMENA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ESSEMENA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ES
Other - Last Name:ANDERSON-BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:STE 1800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-791-9363
Practice Address - Fax:713-795-0488
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3554207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1421794-02Medicaid
TX1101510OtherBEECHSTREET
TX1421794-02Medicaid
TX8L10850Medicare PIN