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Individual

MARY S KISSWANY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1125 W HIGHWAY 30, GONZALES, LA 70737-5004
(225) 621-2975
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0194

Taxonomy

Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
000246
LA
208M00000X
Hospitalist Physician
25MB08436700
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0172146
NJ
01
48090-NON PAR
UHP-PHYS ASSOC OF TEANECK
NJ
01
P00667653
RAILROAD MEDICARE
NJ
01
P00829442
RR MEDICARE-TEANECK
NJ
Enumeration date
07/21/2008
Last updated
11/15/2018
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