Provider Demographics
NPI:1346365319
Name:PRICE, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:PRICE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-253-4463
Mailing Address - Fax:315-253-5624
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-253-4463
Practice Address - Fax:315-253-5624
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03302123Medicaid
NY03302123Medicaid