Provider Demographics
NPI:1346797354
Name:DR.MARK S. ST.MARIE PHYSICIAN PLLC
Entity Type:Organization
Organization Name:DR.MARK S. ST.MARIE PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DELMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:716-671-2130
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:BUILDING A SUITE 104
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-671-2130
Mailing Address - Fax:716-671-5346
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:BUILDING A SUITE 104
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-671-2130
Practice Address - Fax:716-671-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1363121305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization