Provider Demographics
NPI:1205909553
Name:PREWITT, MARYANN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:ELIZABETH
Last Name:PREWITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:STE #304
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-380-1099
Mailing Address - Fax:972-380-0955
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:STE #304
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-380-1099
Practice Address - Fax:972-380-0955
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8337207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F6901Medicare UPIN