Individual
MARY LOU O'NEILL-HUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
121 ERIE CANAL DR, SUITE B, ROCHESTER, NY 14626-4605
(585) 225-5420
(585) 225-5644
Mailing address
600 RED CREEK DR STE 200, ROCHESTER, NY 14623-4300
(585) 222-6566
(585) 225-5505
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
205258
NY
208C00000X
Colon & Rectal Surgery Physician
Primary
205258
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01740234
—
NY
01
—
5795663
AETNA
NY
01
—
MDB767
PREFERRED CARE
NY
01
—
P010205258
BLUES
NY
Enumeration date
03/28/2006
Last updated
01/12/2023
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