Provider Demographics
NPI:1730190570
Name:WISE, MARY CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLAIRE
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4238 W HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-334-8020
Mailing Address - Fax:585-334-8034
Practice Address - Street 1:4138 W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5224
Practice Address - Country:US
Practice Address - Phone:585-334-8020
Practice Address - Fax:585-334-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY146532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine