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General NPI Number Information
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NPI Number | 1144285842
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Entity Type | Individual
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Provider Name | MARY ELLEN VANDERLICK MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 6700 WEST LOOP S STE 400
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City | BELLAIRE
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State | TX
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Zip | 77401-4120
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Country | US
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Telephone | 713-704-6731
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Fax | 713-704-1796
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Provider Business Mailing Address
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Address Line | 6700 WEST LOOP S STE 400
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City | BELLAIRE
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State | TX
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Zip | 77401-4120
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Country | US
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Telephone | 713-795-4785
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Fax | 713-795-5426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | K6386
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License Number State | TX
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