Provider Demographics
NPI:1134294127
Name:WEILER, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:WEILER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3983 WILSON CAMBRIA RD
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-9613
Mailing Address - Country:US
Mailing Address - Phone:716-751-9216
Mailing Address - Fax:
Practice Address - Street 1:3983 WILSON CAMBRIA RD
Practice Address - Street 2:
Practice Address - City:RANSOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:14131-9613
Practice Address - Country:US
Practice Address - Phone:716-751-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114478208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0010186803OtherUNIVERA
NY005064943OtherBCBSWNY
NY0402898OtherINDEPENDENT HEALTH
NY0402898OtherINDEPENDENT HEALTH