Provider Demographics
NPI:1700856820
Name:VEEDER-CIVITELLO, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:VEEDER-CIVITELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 323
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3130
Mailing Address - Country:US
Mailing Address - Phone:315-476-1645
Mailing Address - Fax:315-476-5640
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 323
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3130
Practice Address - Country:US
Practice Address - Phone:315-476-1645
Practice Address - Fax:315-476-5640
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY144217-1207V00000X
NY144217208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00904123Medicaid
NYRB4237Medicare PIN
NYB82415Medicare UPIN
NYRA0871Medicare PIN