Individual
MARY PREM
Active
Individual
MARY PREM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01063227A
IN
207R00000X
Internal Medicine Physician
MT183455
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200873120
—
IN
01
—
MT183455
GRADUATE MEDICAL TRAINEE
PA
Enumeration date
08/10/2006
Last updated
10/16/2023
Update your record
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