Provider Demographics
NPI:1295731016
Name:LEDLEY, ANNMARIE MCRENA (DO)
Entity type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:MCRENA
Last Name:LEDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5639
Mailing Address - Country:US
Mailing Address - Phone:903-455-5986
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:4500 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5644
Practice Address - Country:US
Practice Address - Phone:903-455-5986
Practice Address - Fax:903-454-4621
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6640174400000X, 207VF0040X
PAOS013698207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018018780001Medicaid
TXK6640OtherSTATE LICENSE NUMBER
PAOS013698OtherMEDICAL LICENSE NUMBER
TX092276701Medicaid
TXK6640OtherSTATE LICENSE NUMBER
TX092276701Medicaid
PA104251M02Medicare PIN