Provider Demographics
NPI:1245658608
Name:AGOCS, MARY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:AGOCS
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:UNIT 5120 BOX 2505
Mailing Address - Street 2:DPO
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09845-2505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5120 BOX 2505
Practice Address - Street 2:DPO
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:09845-2505
Practice Address - Country:US
Practice Address - Phone:4122-733-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72681171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider