Provider Demographics
NPI:1275549073
Name:ERNSTOFF, MARC STUART (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:STUART
Last Name:ERNSTOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 MAIN STREET
Mailing Address - Street 2:UNIT 1D
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-0001
Mailing Address - Country:US
Mailing Address - Phone:216-559-6577
Mailing Address - Fax:
Practice Address - Street 1:5014 JUDICIAL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4807
Practice Address - Country:US
Practice Address - Phone:216-559-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138461207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B42156Medicare UPIN
NHRE180602Medicare PIN
B42156Medicare UPIN
NH80001806Medicaid