Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 266547 | NY |
NPI | 1336430081 |
---|---|
Provider Name | Dr. Mary L. Stevenson |
First Address | New York, NY 10016-2708 |
Second Address | New York, NY 10016-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2011 |
Last Update Date | 02/04/2021 |