MEDICARE: DR. MARTIN A BOSCARINO M.D.

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	207W00000X	Ophthalmology Physician	D0063365	MD
2	207W00000X	Ophthalmology Physician	0101238411	VA
3	207W00000X	Ophthalmology Physician	MD035584	DC
4	207W00000X	Ophthalmology Physician	MD430902	PA
5	207W00000X	Ophthalmology Physician	265473	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1654829	OTHER	PA	AETNA HMO/ MEDICARE
5	P00414846	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1566031	OTHER	PA	GATEWAY
3	17583	OTHER	PA	ELDER HEALTH BRAVO
4	411777	OTHER	PA	UPMC HEALTH PLAN
6	251100359	OTHER	PA	CHAMPVA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	7480712	OTHER	PA	AETNA COMMERCIAL
9	000000218020	OTHER	PA	UNISON HEALTH PLAN
10	1951223	OTHER	PA	HIGHMARK
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	675780	OTHER	PA	ADVANTRA/ HEALTH AMERICA

General Provider Information

NPI Number	:	1902850522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN A BOSCARINO M.D.

Provider Business Mailing Address
First Line	:	6480 MAIN ST
Second Line	:	SUITE 1
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5852
Country	:	US
Telephone Number	:	716-631-3300
Fax Number	:	716-631-3303

Provider Business Practice Location Address
First Line	:	6480 MAIN ST
Second Line	:	SUITE 1
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5852
Country	:	US
Telephone Number	:	716-631-3300
Fax Number	:	716-631-3303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/27/2013

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Directions to “ DR. MARTIN A BOSCARINO M.D.” Practice Location

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