| Mary S Kisswany, DO | |
|
1125 W Highway 30, Gonzales, LA 70737-5004 | |
| (225) 621-2975 | |
| Not Available |
| Full Name | Mary S Kisswany |
|---|---|
| Gender | Female |
| Speciality | Hospitalist |
| Location | 1125 W Highway 30, Gonzales, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356506166 | NPI | - | NPPES |
| 0172146 | Medicaid | NJ | |
| P00829442 | Other | NJ | RR MEDICARE-TEANECK |
| P00667653 | Other | NJ | RAILROAD MEDICARE |
| 48090-NON PAR | Other | NJ | UHP-PHYS ASSOC OF TEANECK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208M00000X | Hospitalist | 25MB08436700 (New Jersey) | Secondary |
| 208M00000X | Hospitalist | 000246 (Louisiana) | Primary |
| Entity Name | Hospitalist Physicians Of New Jersey Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1588021851 PECOS PAC ID: 3476859927 Enrollment ID: O20160309000541 |
| Entity Name | Capital Health Multispecialty Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083072342 PECOS PAC ID: 1850689894 Enrollment ID: O20161007000162 |
| Entity Name | Inhospital Physicians Corp Of New Jersey, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336625425 PECOS PAC ID: 2264781780 Enrollment ID: O20180816002176 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary S Kisswany, DO 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 526-0194 | Mary S Kisswany, DO 1125 W Highway 30, Gonzales, LA 70737-5004 Ph: (225) 621-2975 |
Dr. Trevor C. Richard, MD Hospitalist Medicare: Medicare Enrolled Practice Location: 2647 S Saint Elizabeth Blvd, Gonzales, LA 70737 Phone: 225-647-8511 Fax: 225-644-5213 |