Healthcare Provider Details

I. General information

NPI: 1275549073
Provider Name (Legal Business Name): MARC STUART ERNSTOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 JUDICIAL WAY
FREDERICK MD
21703-4807
US

IV. Provider business mailing address

846 MAIN STREET UNIT 1D
BUFFALO NY
14202-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-559-6577
  • Fax:
Mailing address:
  • Phone: 216-559-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number138461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: