Provider Demographics
NPI:1811124555
Name:ELAINE, MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:ELAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:ELAINE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 SPINDRIFT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-631-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278564-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04156176Medicaid