Healthcare Provider Details

I. General information

NPI: 1780698555
Provider Name (Legal Business Name): MARY OBEAR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN ROAD
CORFU NY
14036-9753
US

IV. Provider business mailing address

860 MAIN ROAD
CORFU NY
14036-9753
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-599-3166
Mailing address:
  • Phone: 585-599-6446
  • Fax: 585-599-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY E OBEAR
Title or Position: OWNER
Credential: MD
Phone: 585-599-6446