MEDICARE: MARY GEDA M D P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1063631794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY GEDA M D P A

Provider Business Mailing Address
First Line	:	4534 HIGHWAY 6 N # B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3402
Country	:	US
Telephone Number	:	281-859-8855
Fax Number	:	281-345-0732

Provider Business Practice Location Address
First Line	:	4534 HIGHWAY 6 N # B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3402
Country	:	US
Telephone Number	:	281-859-8855
Fax Number	:	281-345-0732

Authorized Official
Title or Position	:	PEDIATRICIAN PRESIDENT
Name	:	DR. MARY WILMA GEDA
Credential	:	M D
Telephone Number	:	281-859-8855

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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Directions to “MARY GEDA M D P A ” Practice Location

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