1942282207 NPI number — LAWRENCE G RAND MD

Table of content: LAWRENCE G RAND MD (NPI 1942282207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942282207 NPI number — LAWRENCE G RAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAND
Provider First Name:
LAWRENCE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942282207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 NIAGARA FALLS BLVD
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
N TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-692-2160
Provider Business Mailing Address Fax Number:
716-213-0348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4925 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-839-3333
Provider Business Practice Location Address Fax Number:
716-839-3338
Provider Enumeration Date:
11/14/2005

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: 2085R0202X , with the licence number:  01059811 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 134789 , 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: 5607927 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02271878 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01086268 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00804125 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200503240 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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