Provider Demographics
NPI:1699719526
Name:WEBER, MARIA R (RD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:WEBER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 MILESTRIP RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-8594
Mailing Address - Fax:
Practice Address - Street 1:3959 N. BUFFALO ST.
Practice Address - Street 2:STE. 21
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-913-3794
Practice Address - Fax:716-668-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005756133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000926855OtherRD REGISTRATION #