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General NPI Number Information
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NPI Number | 1174546790
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Entity Type | Individual
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Provider Name | MARY CATHERINE MANCINI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 1453 E BERT KOUNS INDUSTRIAL LOOP STE 319
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City | SHREVEPORT
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State | LA
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Zip | 71105-6800
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Country | US
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Telephone | 318-681-1968
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Fax | 318-681-1969
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Provider Business Mailing Address
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Address Line | 919 HIDDEN RDG
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City | IRVING
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State | TX
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Zip | 75038-3813
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Country | US
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Telephone | 469-282-2713
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Fax | 469-282-0996
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD.08695R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD.08695R
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 08695R
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License Number State | LA
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