Basic Information
| Provider Information | |||||||||
| NPI: | 1164443032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWNER | ||||||||
| FirstName: | MARY BETH | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 LAFAYETTE PL | ||||||||
| Address2: | RADIATION ONCOLOGY-2ND FLOOR | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068305426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633773 | ||||||||
| FaxNumber: | 2038633723 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 LAFAYETTE PL | ||||||||
| Address2: | RADIATION ONCOLOGY-2ND FLOOR | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068305426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633773 | ||||||||
| FaxNumber: | 2038633723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 001167 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.