| Doctor Name: | MS. MARY LOUISE DUCHARME |
| NPI Number: | 1801160577 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OTR |
| License Number: | 11244 |
| Business Practice Address: | 5441 Babcock Rd Ste. 200 San Antonio, TX - 782403993 |
| Business Phone Number: | 2106151117 |
| Business Fax Number: | 2102533830 |
| Mailing Address: | 383 Palm Ave, Apt #n IMPERIAL BEACH |
| State: | CA |
| Postal Code: | 919321136 |
| Phone Number: | 5172304475 |
| Fax Number: | 6199341886 |
| NPI Enumeration Date: | 02/28/2012 |
| NPI Last Update Date: | 02/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 11244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |