Individual
DR. MARY L. GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3855 WEST CHESTER PIKE, SUITE 280, NEMOURS DUPONT PEDIATRICS, NEWTON SQUARE, NEWTON SQUARE, PA 19073-2304
(610) 557-4800
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
C10006711
DE
208000000X
Pediatrics Physician
Primary
MD418266
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101018361
—
PA
05
—
36790
—
NJ
05
—
4053079
—
MD
Enumeration date
10/13/2006
Last updated
10/03/2014
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