Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 240467 | NY |
Y | 207P00000X | Emergency Physician | 240467 | NY |
N | 207P00000X | Emergency Physician | 3811 | AZ |
NPI | 1649242942 |
---|---|
Provider Name | Maria K. Gentry |
First Address | Ithaca, NY 14850-2664 |
Second Address | Ithaca, NY 14850-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 07/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02853212 | (05) | NY |
856784 | (05) | AZ |
AZ0755700 | BLUECROSS BLUESHIELD (01) | AZ |
I05860 | (02) |