Provider Demographics
NPI:1811992456
Name:HUTCHESON, MARY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LEE
Last Name:HUTCHESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W BUSCH BLVD
Mailing Address - Street 2:STE 800
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4524
Mailing Address - Country:US
Mailing Address - Phone:813-935-6060
Mailing Address - Fax:813-933-8096
Practice Address - Street 1:2529 W BUSCH BLVD
Practice Address - Street 2:STE 800
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4524
Practice Address - Country:US
Practice Address - Phone:813-935-6060
Practice Address - Fax:813-933-8096
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00479962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30928OtherBCBS
FL30928OtherBCBS
FL378104600Medicaid