Provider Demographics
NPI:1972772838
Name:ROEHMHOLDT, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:ROEHMHOLDT
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:300 ESSJAY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8208
Mailing Address - Country:US
Mailing Address - Phone:716-634-6357
Mailing Address - Fax:716-634-3448
Practice Address - Street 1:300 ESSJAY RD
Practice Address - Street 2:STE 105
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8208
Practice Address - Country:US
Practice Address - Phone:716-634-6357
Practice Address - Fax:716-634-3448
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128036-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCPN-N-128036-1OtherNYS COMPENSATION
NY00481021Medicaid
NY130003589OtherMEDICARE RAILROAD
NY00020058901OtherUNIVERA
NY005077825OtherBLUE CROSS /BLUE SHIELD
NY389594OtherWELLCARE
NY05-02672OtherIHA
NY00481021Medicaid
NY389594OtherWELLCARE