Provider Demographics
NPI:1467686428
Name:DUSON, SIRA MARY (MD)
Entity type:Individual
Prefix:
First Name:SIRA
Middle Name:MARY
Last Name:DUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 S GREENE ST # S10B00
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-5840
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-7272
Practice Address - Fax:901-545-8292
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0423352086S0129X
TN700742086S0129X
MDD818742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery