Provider Demographics
NPI:1134237001
Name:CAVALIER, MARY ELLEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:CAVALIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6023
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0226
Mailing Address - Country:US
Mailing Address - Phone:469-213-7634
Mailing Address - Fax:469-535-3664
Practice Address - Street 1:7002 LEBANON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7461
Practice Address - Country:US
Practice Address - Phone:469-213-7634
Practice Address - Fax:469-535-3664
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9913208000000X, 2080P0207X
GA0601612080P0207X
SCMD 283342080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC283348Medicaid
I43722Medicare UPIN
SC283348Medicaid