Healthcare Provider Details

I. General information

NPI: 1013977495
Provider Name (Legal Business Name): MARY LOU O'NEILL-HUBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ERIE CANAL DR SUITE B
ROCHESTER NY
14626-4605
US

IV. Provider business mailing address

600 RED CREEK DR STE 200
ROCHESTER NY
14623-4300
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-5420
  • Fax: 585-225-5644
Mailing address:
  • Phone: 585-222-6566
  • Fax: 585-225-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number205258
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number205258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: