Provider Demographics
NPI:1457564759
Name:GUGGENHEIM, MARY ANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:GUGGENHEIM
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 1:7575 PRIEST PASS RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-9666
Mailing Address - Country:US
Mailing Address - Phone:406-443-5006
Mailing Address - Fax:928-447-7713
Practice Address - Street 1:7575 PRIEST PASS RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9666
Practice Address - Country:US
Practice Address - Phone:406-443-5006
Practice Address - Fax:928-447-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45052084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology