Provider Demographics
NPI:1447646369
Name:GAGNIER, ELIZABETH K (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:GAGNIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAND RE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1742
Mailing Address - Country:US
Mailing Address - Phone:585-368-6620
Mailing Address - Fax:585-368-6621
Practice Address - Street 1:4 LAND RE WAY STE 100
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-368-6620
Practice Address - Fax:585-368-6621
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine