Provider Demographics
NPI:1396702486
Name:MAULUCCI, MARINA A (DPM)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:A
Last Name:MAULUCCI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 ELLICOTT CREEK RD
Mailing Address - Street 2:STE 1
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2935
Mailing Address - Country:US
Mailing Address - Phone:716-886-8289
Mailing Address - Fax:716-886-8303
Practice Address - Street 1:1540 ELLICOTT CREEK RD
Practice Address - Street 2:STE 1
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2935
Practice Address - Country:US
Practice Address - Phone:716-886-8289
Practice Address - Fax:716-886-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003952213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010254002OtherUNIVERA ELLICOTT CREEK OF
NY000500995001OtherBCBS ALL
NY480005207OtherMEDICARE RAILROAD
NY000500995004OtherBCBS DME
NY00010254001OtherUNIVERA
NY00975291Medicaid
NY8905488OtherINDEPENDENT HEALTH
NY480005207OtherMEDICARE RAILROAD
NYT25951Medicare UPIN