Provider Demographics
NPI:1639102874
Name:ANDAYA, MARIA RITA P (MD)
Entity Type:Individual
Prefix:
First Name:MARIA RITA
Middle Name:P
Last Name:ANDAYA
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 1:1344 MCKINLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1643
Mailing Address - Country:US
Mailing Address - Phone:716-549-4724
Mailing Address - Fax:
Practice Address - Street 1:286 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-1032
Practice Address - Country:US
Practice Address - Phone:716-549-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207380-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020009402OtherUNIVERA
NYP00081666OtherRAILROAD MEDICARE
NY01918950Medicaid
NY000524448002OtherBLUE CROSS BLUE SHIELD
NY0408441OtherINDEPENDENT HEALTH
NYP00081666OtherRAILROAD MEDICARE
NY00020009402OtherUNIVERA