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General NPI Number Information
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NPI Number | 1508081613
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Entity Type | Individual
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Provider Name | MARY EDER RPA-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1900 RIDGE RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3332
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Country | US
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Telephone | 716-712-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 6805 LAKE SHORE RD
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City | DERBY
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State | NY
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Zip | 14047-9748
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Country | US
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Telephone | 716-947-5568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 009301
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License Number State | NY
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