MEDICARE: MARY KATHRYN ALDERSON MD

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	2084N0400X	Neurology Physician	167897-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891791034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHRYN ALDERSON MD

Provider Business Mailing Address
First Line	:	1151 E 3900 S
Second Line	:	# B150
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1216
Country	:	US
Telephone Number	:	801-262-3441
Fax Number	:	801-269-9005

Provider Business Practice Location Address
First Line	:	166 E 5900 S
Second Line	:	STE B106
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7350
Country	:	US
Telephone Number	:	801-743-6444
Fax Number	:	801-743-6888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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