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General NPI Number Information
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NPI Number | 1871589861
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Entity Type | Organization
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Legal Business Name | MAPLE MEDICAL SERVICES, P.C.
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Dates
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Enumeration Date | 09/25/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 41 MAPLE RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2918
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Country | US
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Telephone | 716-631-1045
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Fax | 716-631-1365
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Provider Business Mailing Address
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Address Line | 41 MAPLE RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2918
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Country | US
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Telephone | 716-631-1045
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Fax | 716-631-1365
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Authorized Official
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Title or Position | OWNER
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Name | THEODORE GERARD COSTICH
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Credential | M.D.
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Telephone | 716-631-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 187420
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 187420
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License Number State | NY
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