Individual
MARIEL DAVILA-MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2655 RIDGEWAY AVE, SUITE 420, ROCHESTER, NY 14626-4296
(585) 723-7972
(585) 368-3119
Mailing address
2655 RIDGEWAY AVE, SUITE 420, ROCHESTER, NY 14626-4296
(585) 723-7972
(585) 368-3119
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
279321
NY
2084N0600X
Clinical Neurophysiology Physician
279321
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04499372
—
NY
01
—
P01790959
MEDICARE RR
NY
Enumeration date
06/03/2011
Last updated
04/20/2017
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