Provider Information for 1104042688
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MARY WELLINGTON
Sex: Female
NPI: 1104042688
Last Updated: 2009-08-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1104042688 | ||||||||||||
| Enumeration Date | 2007-04-17 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 227 THORN AVE PO BOX 631 ORCHARD PARK, NY 14127-2600 United States Phone: 716-662-2040 | Fax:716-662-0019 | ||||||||||||
| Primary Practice Address | 326 ORCHARD PARK RD WEST SENECA, NY 14224-2635 United States Phone: 716-828-1719 | Fax:716-828-9275 | ||||||||||||
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