Provider Demographics
NPI:1619296902
Name:MACLIN, MARISSA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:A
Last Name:MACLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1706
Mailing Address - Country:US
Mailing Address - Phone:347-432-6769
Mailing Address - Fax:
Practice Address - Street 1:INTEGRATIVE PAIN & WELLNESS
Practice Address - Street 2:1360 N. FOREST RD. SUITE 117
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-650-3000
Practice Address - Fax:716-650-3090
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY281733207L00000X, 208VP0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program