Provider Demographics
NPI:1669516423
Name:POSS, MARIOLA B (MD)
Entity type:Individual
Prefix:
First Name:MARIOLA
Middle Name:B
Last Name:POSS
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 1:199 PARK CLUB LN STE 100
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5269
Mailing Address - Country:US
Mailing Address - Phone:716-332-6834
Mailing Address - Fax:
Practice Address - Street 1:199 PARK CLUB LN STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5269
Practice Address - Country:US
Practice Address - Phone:716-332-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6965208600000X
NY279073208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery