Provider Demographics
NPI:1841300100
Name:FLEMING, MARY M (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 SPRING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-2930
Mailing Address - Country:US
Mailing Address - Phone:812-282-1367
Mailing Address - Fax:812-284-8377
Practice Address - Street 1:1701 SPRING ST
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-2930
Practice Address - Country:US
Practice Address - Phone:812-282-1367
Practice Address - Fax:812-284-8377
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1031604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100316780Medicaid