Provider Demographics
NPI:1962431601
Name:MUTTON, HOLLY BETH (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:BETH
Last Name:MUTTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:108 OLD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2402
Mailing Address - Country:US
Mailing Address - Phone:716-689-4573
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST, ECMC, ROOM 1168
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4535
Practice Address - Fax:716-898-4538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2370032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry