1073568358 NPI number — BARBARA S STOUTER MD

Table of content: BARBARA S STOUTER MD (NPI 1073568358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073568358 NPI number — BARBARA S STOUTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOUTER
Provider First Name:
BARBARA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAFEE
Provider Other First Name:
BARBARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073568358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 ABBOTT RD
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14220-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-995-8801
Provider Business Mailing Address Fax Number:
716-995-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 ABBOTT RD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14220-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-995-8801
Provider Business Practice Location Address Fax Number:
716-995-8810
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  183576 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205912 . This is a "IHA LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139305-7W . This is a "WORKERS COMP LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8494418 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426003018 . This is a "FIDELIS LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 159921DL . This is a "PREFERRED CARE LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000523215006 . This is a "HEALTH NOW BCBS LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000082563 . This is a "GHI HMO LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010154302 . This is a "UNIVERA LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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