Provider Demographics
NPI:1013232230
Name:MARTINICK, MAISIE IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAISIE
Middle Name:IRENE
Last Name:MARTINICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5300 MILITARY ROAD
Mailing Address - Street 2:MOUNT ST. MARY'S HOSPITAL
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092
Mailing Address - Country:US
Mailing Address - Phone:716-297-4800
Mailing Address - Fax:804-828-8682
Practice Address - Street 1:1200 E. BROAD STREET WEST HOSPITAL - W6S
Practice Address - Street 2:GME ADMINISTRATION POB 980257
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0257
Practice Address - Country:US
Practice Address - Phone:804-828-9783
Practice Address - Fax:804-828-5613
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2020-03-18
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Provider Licenses
StateLicense IDTaxonomies
NY9544203207L00000X
VA0101257763207L00000X
NY272924207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology