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1093709867

NPI Code Detail

MEDICARE: MARY KATHERINE KOLBERT MD

MEDICARE: MARY KATHERINE KOLBERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2233141	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	155613BF	OTHER	NY	PREFERRED CARE #
3	00025946204	OTHER	NY	UNIVERA#
4	223314-6W	OTHER	NY	WORKERS COMP #
5	000526688004	OTHER	NY	HEALTH NOW BCBS # FOR MM
6	0111374	OTHER	NY	IHA #
7	061205000050	OTHER	NY	FIDELIS # FOR MM
8	000526688005	OTHER	NY	HEALTH NOW BCBS # FOR HAM
9	061205000052	OTHER	NY	FIDELIS # FOR HAM

General Provider Information

NPI Number	:	1093709867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHERINE KOLBERT MD

Provider Business Mailing Address
First Line	:	425 ESSJAY RD STE 170
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8235
Country	:	US
Telephone Number	:	716-630-1219
Fax Number	:	716-817-1726

Provider Business Practice Location Address
First Line	:	3900 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1842
Country	:	US
Telephone Number	:	716-630-1143
Fax Number	:	716-817-1766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	12/20/2021

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Directions to “ MARY KATHERINE KOLBERT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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