Provider Demographics
NPI:1487928834
Name:MARY M TSE MD PC
Entity type:Organization
Organization Name:MARY M TSE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-776-7458
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5210
Mailing Address - Country:US
Mailing Address - Phone:203-776-7458
Mailing Address - Fax:203-776-2401
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:STE 301
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5210
Practice Address - Country:US
Practice Address - Phone:203-776-7458
Practice Address - Fax:203-776-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty