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Individual
MARY AMATO TYSON
Active
Individual
MARY AMATO TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9400191
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10999
BLUE CROSS BLUE SHIELD
NC
05
—
8910999
—
NC
Enumeration date
02/17/2006
Last updated
10/26/2017
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