Provider Demographics
NPI:1801233820
Name:MEGALLY, MARY MOSSAD (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MOSSAD
Last Name:MEGALLY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:27301 DEQUINDRE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3473
Mailing Address - Country:US
Mailing Address - Phone:248-541-2551
Mailing Address - Fax:248-541-1405
Practice Address - Street 1:27301 DEQUINDRE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3473
Practice Address - Country:US
Practice Address - Phone:248-541-2551
Practice Address - Fax:248-541-1405
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2016-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010202962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology