Basic Information
| Provider Information | |||||||||
| NPI: | 1730173121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARST | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342696337 | ||||||||
| FaxNumber: | 3348340657 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 00020068 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME90123 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD20068 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000058707 | 05 | AL | MEDICAID | 009952755 | 05 | AL | MEDICAID | 009973265 | 05 | AL | MEDICAID | 107069 | 05 | AL | MEDICAID | 000055025 | 05 | AL | MEDICAID | 009927920 | 05 | AL | MEDICAID | 009973245 | 05 | AL | MEDICAID | 009973255 | 05 | AL | MEDICAID | 107042 | 05 | AL | MEDICAID | 009973235 | 05 | AL | MEDICAID | 051523069 | 01 | AL | BC/BS PIN | OTHER | 000045114 | 05 | AL | MEDICAID | 000045115 | 05 | AL | MEDICAID | 108565 | 05 | AL | MEDICAID | 270020400 | 05 | FL | MEDICAID | 000045162 | 05 | AL | MEDICAID | 051045114 | 01 | AL | BC/BS PIN | OTHER |