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Individual
MARY ELLEN KING
Active
Individual
MARY ELLEN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
220224
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
220224
NY
208M00000X
Hospitalist Physician
220224
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02192372
—
NY
01
—
MK0027SX20
BCBS
NY
Enumeration date
07/07/2006
Last updated
02/20/2024
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