Organization
MAPLE MEDICAL SERVICES, P.C.
Active
Organization
MAPLE MEDICAL SERVICES, P.C.
Active
Other names
Theodore G. Costich, MD
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE GERARD COSTICH M.D. (OWNER)
(716) 631-1045
Entity
Organization
Contact information
Practice address
41 MAPLE RD, WILLIAMSVILLE, NY 14221-2918
(716) 631-1045
(716) 631-1365
Mailing address
41 MAPLE RD, WILLIAMSVILLE, NY 14221-2918
(716) 631-1045
(716) 631-1365
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
187420
NY
207VX0000X
Obstetrics Physician
Primary
187420
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020006503
UNIVERA ID #
NY
05
—
01406720
—
NY
01
—
0709667
IHA PROVIDER #
NY
Enumeration date
09/25/2005
Last updated
09/11/2025
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