Provider Demographics
NPI:1053309179
Name:WIART, MAURICE GEORGE (MD)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:GEORGE
Last Name:WIART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FOX HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1144
Mailing Address - Country:US
Mailing Address - Phone:518-745-7670
Mailing Address - Fax:
Practice Address - Street 1:41 FOX HOLLOW LN
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1144
Practice Address - Country:US
Practice Address - Phone:518-745-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F49122Medicare UPIN