Healthcare Provider Details

I. General information

NPI: 1861449803
Provider Name (Legal Business Name): MARY T DELANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M. THERESE MASTRUCCI M.D.

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N UNION ST
OLEAN NY
14760-2736
US

IV. Provider business mailing address

135 N UNION ST
OLEAN NY
14760-2736
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7500
  • Fax: 716-701-6854
Mailing address:
  • Phone: 716-375-7500
  • Fax: 716-701-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number187190
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01272802
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: