Healthcare Provider Details

I. General information

NPI: 1134294127
Provider Name (Legal Business Name): MARY MARGARET WEILER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 WILSON CAMBRIA RD
RANSOMVILLE NY
14131-9613
US

IV. Provider business mailing address

3983 WILSON CAMBRIA RD
RANSOMVILLE NY
14131-9613
US

V. Phone/Fax

Practice location:
  • Phone: 716-751-9216
  • Fax:
Mailing address:
  • Phone: 716-751-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number114478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: