Basic Information
| Provider Information | |||||||||
| NPI: | 1760748842 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY ANN CHENG MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4909 LACLEDE AVE | ||||||||
| Address2: | APARTMENT 1006 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865550 | ||||||||
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| Address1: | 4909 LACLEDE AVE APT 1006 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367571971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 04/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHENG | ||||||||
| AuthorizedOfficialFirstName: | MARY ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5736865550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.