Provider Demographics
NPI:1033127055
Name:GOSWITZ, MARY S (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:GOSWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-1297
Mailing Address - Country:US
Mailing Address - Phone:281-420-8557
Mailing Address - Fax:281-427-2911
Practice Address - Street 1:4021 GARTH RD
Practice Address - Street 2:STE #105
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3160
Practice Address - Country:US
Practice Address - Phone:281-420-8557
Practice Address - Fax:281-427-2911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ69722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018GKOtherBCBS
TX103039703Medicaid
TX10017453OtherAMERIGROUP
TXTXB109855Medicare PIN