Provider Demographics
NPI:1730173121
Name:KARST, MARY M (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:KARST
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 1:2055 NORMANDIE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000200682085R0202X
FLME901232085R0202X
ALMD200682085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058707Medicaid
AL009952755Medicaid
AL009973265Medicaid
AL107069Medicaid
AL000055025Medicaid
AL009927920Medicaid
AL009973245Medicaid
AL009973255Medicaid
AL107042Medicaid
AL009973235Medicaid
AL051523069OtherBC/BS PIN
AL000045114Medicaid
AL000045115Medicaid
AL108565Medicaid
FL270020400Medicaid
AL000045162Medicaid
AL051045114OtherBC/BS PIN
AL107042Medicaid
FL270020400Medicaid
AL009927920Medicaid
AL107069Medicaid
AL051524492Medicare PIN
AL108565Medicaid