Provider Demographics
NPI:1447287024
Name:MUSE, MARY B (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:MUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2263
Mailing Address - Country:US
Mailing Address - Phone:607-734-2264
Mailing Address - Fax:607-767-0340
Practice Address - Street 1:302 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2263
Practice Address - Country:US
Practice Address - Phone:607-734-2264
Practice Address - Fax:607-767-0340
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01087609Medicaid
53030LMedicare ID - Type Unspecified
NY01087609Medicaid