Individual
MARY LOU DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
964 DELAWARE AVE, BUFFALO, NY 14209-1806
(716) 863-0196
Mailing address
964 DELAWARE AVE, BUFFALO, NY 14209-1806
(716) 863-0196
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0003041-1
NY
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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