Provider Demographics
NPI:1437339447
Name:MARY LOUISE LENAHAN
Entity type:Organization
Organization Name:MARY LOUISE LENAHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-689-4377
Mailing Address - Street 1:9388 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1494
Mailing Address - Country:US
Mailing Address - Phone:716-689-4377
Mailing Address - Fax:716-689-4843
Practice Address - Street 1:9388 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1494
Practice Address - Country:US
Practice Address - Phone:716-689-4377
Practice Address - Fax:716-689-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153446-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010102801OtherUNIVERA
NY0301329OtherIHA
NY000500619001OtherBCBS OF WNY
NY00010102801OtherUNIVERA
NY0301329OtherIHA