Provider Demographics
NPI:1093709867
Name:KOLBERT, MARY KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:KOLBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:3900 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1842
Practice Address - Country:US
Practice Address - Phone:716-630-1143
Practice Address - Fax:716-817-1766
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2233141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02219336Medicaid
NY155613BFOtherPREFERRED CARE #
NY00025946204OtherUNIVERA#
NY223314-6WOtherWORKERS COMP #
NY000526688004OtherHEALTH NOW BCBS # FOR MM
NY0111374OtherIHA #
NY061205000050OtherFIDELIS # FOR MM
NY000526688005OtherHEALTH NOW BCBS # FOR HAM
NY061205000052OtherFIDELIS # FOR HAM
NY00025946204OtherUNIVERA#
NY061205000052OtherFIDELIS # FOR HAM