Individual
DR. MARY ELLEN VANDERLICK
Active
Individual
DR. MARY ELLEN VANDERLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
K6386
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00106W
MISCHER GRP MDCR PTAN HARRIS CO
TX
01
—
0035TD
MISCHER BCBSTX GRP PROV REC
TX
01
—
153449704
MISCHER GRP MDCD HARRIS CO TPI
TX
Enumeration date
04/18/2006
Last updated
09/25/2024
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