1295722486 NPI number — KATHLEEN M MYLOTTE M.D.

Table of content: KATHLEEN M MYLOTTE M.D. (NPI 1295722486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295722486 NPI number — KATHLEEN M MYLOTTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYLOTTE
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1295722486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2875 UNION RD
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14227-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-651-0911
Provider Business Mailing Address Fax Number:
716-651-9855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7264 NASH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14120-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-694-7700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2005

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: 207RG0300X , with the licence number:  125943 , 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: 2208900 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 151122BJ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01043461 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040511000519 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010124505 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000508674005 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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