Provider Demographics
NPI:1427083203
Name:YOUSSEF, MARY GEORGE HANNA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GEORGE HANNA
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S EDMONDS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3624
Mailing Address - Country:US
Mailing Address - Phone:972-434-1988
Mailing Address - Fax:972-436-0351
Practice Address - Street 1:1000 FLOWER MOUND RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3401
Practice Address - Country:US
Practice Address - Phone:972-434-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5191207RC0000X
WI51405-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427083203OtherNHP
TX110242559OtherRAILROAD MEDICARE
TX120722OtherSUPERIOR
TX153905802Medicaid
WI35131600Medicaid
TX8B9058OtherBLUE CROSS
WI35131600Medicaid
TX8760B9Medicare PIN
TX110242559Medicare PIN
H31012Medicare UPIN
TX153905802Medicaid