MEDICARE: MARY ANGELA MCLELLAN-DESAI 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	207V00000X	Obstetrics & Gynecology Physician	229046	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

General Provider Information

NPI Number	:	1841257177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANGELA MCLELLAN-DESAI MD

Provider Business Mailing Address
First Line	:	PO BOX 488
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14240-0488
Country	:	US
Telephone Number	:	203-944-1940
Fax Number	:	203-402-4192

Provider Business Practice Location Address
First Line	:	705 MAPLE RD
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-3291
Country	:	US
Telephone Number	:	716-656-4077
Fax Number	:	716-458-0271

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	05/16/2019

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