Provider Demographics
NPI:1528031697
Name:BISHARA, MARY ANN ZAVISCA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:ZAVISCA
Last Name:BISHARA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5290 MILITARY RD
Mailing Address - Street 2:MT ST MARY MEDICAL ARTS ROOM 6
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092
Mailing Address - Country:US
Mailing Address - Phone:716-297-2998
Mailing Address - Fax:716-298-2025
Practice Address - Street 1:5290 MILITARY RD
Practice Address - Street 2:MT ST MARY MEDICAL ARTS BLDG ROOM 6
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092
Practice Address - Country:US
Practice Address - Phone:716-297-2998
Practice Address - Fax:716-298-2025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY84509207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00589551Medicaid
NY021461Medicare ID - Type Unspecified
NY00589551Medicaid