Provider Demographics
NPI:1194746958
Name:WUST-SMITH, MARLENE (MD)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:WUST-SMITH
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:315-359-2660
Mailing Address - Fax:315-359-2635
Practice Address - Street 1:45 N PINE ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1238
Practice Address - Country:US
Practice Address - Phone:814-642-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138880208000000X
PAMD428746208000000X
TN58483208000000X
TXS2202208000000X
NY185375208000000X
OH35.134106208000000X
ORMD190049208000000X
GA039985208000000X
VA0101265911208000000X
CAG159436208000000X
NJ25MA10475500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74845Medicare UPIN