Provider Demographics
NPI:1902850522
Name:BOSCARINO, MARTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:BOSCARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-631-3300
Mailing Address - Fax:716-631-3303
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-631-3300
Practice Address - Fax:716-631-3303
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063365207W00000X
VA0101238411207W00000X
DCMD035584207W00000X
PAMD430902207W00000X
NY265473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1654829OtherAETNA HMO/ MEDICARE
PA1566031OtherGATEWAY
PA17583OtherELDER HEALTH BRAVO
PA411777OtherUPMC HEALTH PLAN
PAP00414846OtherRAILROAD MEDICARE
PA251100359OtherCHAMPVA
PA1019092900001Medicaid
PA7480712OtherAETNA COMMERCIAL
PA000000218020OtherUNISON HEALTH PLAN
PA1951223OtherHIGHMARK
MD408297400Medicaid
PA675780OtherADVANTRA/ HEALTH AMERICA
PAP00414846OtherRAILROAD MEDICARE
PA1566031OtherGATEWAY
PA111228EVXMedicare PIN