MEDICARE: MAPLE INTERNAL MEDICINE & PEDIATRICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		NY
2	207R00000X	Internal Medicine Physician		NY

General Provider Information

NPI Number	:	1578520854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE INTERNAL MEDICINE & PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	1835 MAPLE RD STE 1
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2780
Country	:	US
Telephone Number	:	716-634-5410
Fax Number	:	716-634-0430

Provider Business Practice Location Address
First Line	:	1835 MAPLE RD STE 1
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2780
Country	:	US
Telephone Number	:	716-634-5410
Fax Number	:	716-634-0430

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. WILLIAM M HARTRICH
Credential	:	M.D.
Telephone Number	:	716-634-5410

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	12/22/2014

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