Provider Demographics
NPI:1639245186
Name:BUETTI-SGOUROS, MARYANN (MD,)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:BUETTI-SGOUROS
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 1:92 W LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3133
Mailing Address - Country:US
Mailing Address - Phone:845-628-8277
Mailing Address - Fax:
Practice Address - Street 1:880 S LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4771
Practice Address - Country:US
Practice Address - Phone:845-628-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics