Provider Demographics
NPI:1902808918
Name:MCKEE, MARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-2269
Practice Address - Fax:505-272-5821
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD 2006-06042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3063382Medicaid
NM31325378Medicaid
TN3031606OtherBLUE CROSS PROVIDER NUMBE
NM342724839Medicare PIN
TN3063382Medicaid
TNF00698Medicare UPIN