Provider Demographics
NPI:1780698555
Name:MARY OBEAR MD PLLC
Entity type:Organization
Organization Name:MARY OBEAR MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OBEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-599-6446
Mailing Address - Street 1:860 MAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9753
Mailing Address - Country:US
Mailing Address - Phone:585-599-6446
Mailing Address - Fax:585-599-3166
Practice Address - Street 1:860 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9753
Practice Address - Country:US
Practice Address - Phone:585-599-6446
Practice Address - Fax:585-599-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03044906Medicaid
NYAA1316Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER