Provider Demographics
NPI:1356339220
Name:ZESIEWICZ, MARY F (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:F
Last Name:ZESIEWICZ
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 1:3130 SW 27TH AVE FL 34471
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4306
Mailing Address - Country:US
Mailing Address - Phone:352-671-3130
Mailing Address - Fax:
Practice Address - Street 1:3130 SW 27TH AVE FL 34471
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4306
Practice Address - Country:US
Practice Address - Phone:352-671-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1607942084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86277243Medicaid
ND528998Medicare ID - Type Unspecified
CO86277243Medicaid
COH1638Medicare UPIN