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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