Individual
MARY AMATO TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-5345
(919) 477-5474
Mailing address
PO BOX 15386, DURHAM, NC 27704-0386
(919) 477-5152
(919) 477-5474
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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