Provider Demographics
NPI:1952312936
Name:STOCK, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:STOCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:80 WESTPORT CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1300
Mailing Address - Country:US
Mailing Address - Phone:716-829-3316
Mailing Address - Fax:716-829-2564
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:UNIVERSITY AT BUFFALO STUDENT HEALTH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-3316
Practice Address - Fax:716-829-2564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG52204Medicare UPIN