Provider Demographics
NPI:1497717888
Name:MUCCIARELLA, ROSALBA (MD)
Entity Type:Individual
Prefix:
First Name:ROSALBA
Middle Name:
Last Name:MUCCIARELLA
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 1:297 SPINDRIFT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-635-0688
Mailing Address - Fax:716-635-0157
Practice Address - Street 1:297 SPINDRIFT DR
Practice Address - Street 2:STE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-635-0688
Practice Address - Fax:716-635-0157
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01683783Medicaid
CC5493Medicare ID - Type Unspecified
NY01683783Medicaid