Provider Demographics
NPI:1336433440
Name:LYTWYN, MARY KATHARINE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:LYTWYN
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 1:7 TANNERY HILL RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4980
Mailing Address - Country:US
Mailing Address - Phone:956-472-1238
Mailing Address - Fax:
Practice Address - Street 1:20171 CHASEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1437
Practice Address - Country:US
Practice Address - Phone:832-534-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173193390200000X
TXP9132207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program