Active NPI
Mary Quiceno, M.D.
- Neurology Physician
- Fort Worth, TX
National Provider Identifier
1497754162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- L6149
- Practice address
- 855 Montgomery St
Fort Worth, TX 76107-2553 - Phone
- (817) 735-2200
- Fax
- (817) 735-5441
- NPI assigned
- Jul 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | L6149 | TX | Primary |
Addresses
Primary practice location
855 Montgomery St
Fort Worth, TX 76107-2553
Mailing address
855 Montgomery St
Fort Worth, TX 76107-2553
Phone (817) 735-2200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L6149 | TX | MD | Neurology Physician |
Interoperability endpoints
- mary.quiceno.1@17617.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518134400000",
"number": "1497754162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "855 MONTGOMERY ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072553",
"telephone_number": "817-735-2200",
"fax_number": "817-735-5441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 MONTGOMERY ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072553",
"telephone_number": "817-735-2200",
"fax_number": "817-735-5441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUICENO",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-15",
"last_updated": "2018-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "L6149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.