Provider Demographics
NPI:1801899521
Name:FRANCISCO, MARY PAT (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAT
Last Name:FRANCISCO
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 2A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-224-3375
Practice Address - Fax:423-378-5940
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 280962080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3803956Medicaid
KY64110612Medicaid
VA6715184Medicaid
TN3803956Medicaid
VA6715184Medicaid
0281780003Medicare PIN
F26026Medicare UPIN
TN3803959Medicare ID - Type Unspecified