Provider Demographics
NPI:1093077471
Name:MAHAR, GINA MARIE (MS, ED)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:MAHAR
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:GRUTTADAURIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ED
Mailing Address - Street 1:590 FISHERS STATION DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9744
Mailing Address - Country:US
Mailing Address - Phone:585-924-7207
Mailing Address - Fax:585-924-7049
Practice Address - Street 1:590 FISHERS STATION DR
Practice Address - Street 2:SUITE 130
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9744
Practice Address - Country:US
Practice Address - Phone:585-924-7207
Practice Address - Fax:585-924-7049
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist