Individual
MARIA K. GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
200 PLEASANT GROVE RD, SUITE # 6, ITHACA, NY 14850-2664
(607) 257-0900
(607) 257-0997
Mailing address
200 PLEASANT GROVE RD, SUITE # 6, ITHACA, NY 14850-2664
(607) 257-0900
(607) 257-0997
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
240467
NY
207P00000X
Emergency Medicine Physician
Primary
240467
NY
207P00000X
Emergency Medicine Physician
3811
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02853212
—
NY
05
—
856784
—
AZ
01
—
AZ0755700
BLUECROSS BLUESHIELD
AZ
Enumeration date
02/02/2006
Last updated
07/07/2011
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