Healthcare Provider Details

I. General information

NPI: 1407434517
Provider Name (Legal Business Name): MARY CATHERINE ERNSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY C MOORE

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4997
  • Fax:
Mailing address:
  • Phone: 608-824-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85282-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: