Provider Demographics
NPI:1487697389
Name:RANSOM, MARY M (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:RANSOM
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 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-893-8656
Mailing Address - Fax:804-287-7018
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 207
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-893-8656
Practice Address - Fax:804-287-7018
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012482262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487697389OtherNPI
VAC06778OtherGROUP PTAN