Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 214652 | NY |
NPI | 1013973734 |
---|---|
Provider Name | Dr. Mary M Wilsch |
First Address | Penfield, NY 14526-2687 |
Second Address | Penfield, NY 14526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H27248 | (02) |