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NPI Code Detail

MEDICARE: MARY BETH KANSORA M.D.

MEDICARE: MARY BETH KANSORA M.D.
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
1207W00000XOphthalmology Physician200000480NC
2207W00000XOphthalmology PhysicianME131063FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2093AGOTHERNCBC/BS PROVIDER NUMBER

General Provider Information

NPI Number : 1881698645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BETH KANSORA M.D.
Provider Business Mailing Address
First Line : 3880 TAMIAMI TRL N
Second Line :
City : NAPLES
State : FL
Zip : 34103-3504
Country : US
Telephone Number : 239-659-3937
Fax Number :
Provider Business Practice Location Address
First Line : 3880 TAMIAMI TRL N
Second Line :
City : NAPLES
State : FL
Zip : 34103-3504
Country : US
Telephone Number : 239-659-3937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 03/17/2018

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