Provider Demographics
NPI:1700894540
Name:BESANA, MARY ANN CAROL CARLOS I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN CAROL
Middle Name:CARLOS
Last Name:BESANA
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY ANN CAROL
Other - Middle Name:CARLOS
Other - Last Name:BESANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3285 CLAREMONT WAY
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3313
Mailing Address - Country:US
Mailing Address - Phone:707-258-2166
Mailing Address - Fax:
Practice Address - Street 1:3285 CLAREMONT WAY
Practice Address - Street 2:MEDICINE 3
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3313
Practice Address - Country:US
Practice Address - Phone:707-258-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02527791Medicaid
NY02527791Medicaid
NY5258B1Medicare ID - Type Unspecified