Individual
MARY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-3482
Mailing address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-3482
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
171288
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000524980003
BLUE CROSS OF WNY
NY
Enumeration date
08/02/2006
Last updated
06/06/2008
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