Provider Demographics
NPI:1255893384
Name:CEESAY, MAMARAM (MD)
Entity type:Individual
Prefix:
First Name:MAMARAM
Middle Name:
Last Name:CEESAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 38TH ST STE 705
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1016
Mailing Address - Country:US
Mailing Address - Phone:512-324-7036
Mailing Address - Fax:
Practice Address - Street 1:1301 W 38TH ST STE 705
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1016
Practice Address - Country:US
Practice Address - Phone:512-324-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10066806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10066806OtherPHYSICIAN-IN-TRAINING