Madonna, Mary Beth

Madonna, Mary Beth is an individual health care provider with primary practice located at 333 N Santa Rosa , San Antonio TX 78207-3108. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Surgery, which is considered as her primary health care specialty. Madonna, Mary Beth can be contacted via phone (210) 704-4100.

Contact Information

Primary practice address
333 N Santa Rosa San Antonio TX 78207-3108
Phone: (210) 704-4100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Surgery 2086S0120X 036-083049 Illinois
Allopathic & Osteopathic Physicians / Pediatric Surgery 2086S0120X U0254 Texas

Profile Details

NPI number 1265427108
LBN Legal business name Madonna, Mary Beth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 16th, 2005
Last updated Nov 16th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265427108 NPPES
Illinois MEDICAID 036083049
Illinois Other 1627123

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