Provider Demographics
NPI:1881654135
Name:PEARSON, MARY G (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:80 ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3535
Mailing Address - Country:US
Mailing Address - Phone:603-642-6700
Mailing Address - Fax:603-642-6701
Practice Address - Street 1:80 ROUTE 125
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3535
Practice Address - Country:US
Practice Address - Phone:603-642-6700
Practice Address - Fax:603-642-6701
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9106207Q00000X
MA76376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40226429Medicaid
MA723885OtherTUFTS HEALTH PLAN
NH4480241OtherAETNA PPO
NH0402142YPNH01OtherBCBS NH
NH3084720OtherAETNA HMO
NH15221OtherCIGNA NH
MAB10383301OtherCIGNA MASSACHUSETTS
MA3119076Medicaid
MAF30970OtherHARVARD PILGRIM
MAJ12643OtherBCBS MA
NH15221OtherCIGNA NH
MAB10383301OtherCIGNA MASSACHUSETTS
F30970Medicare UPIN