MEDICARE: LYNNE MARIE FRIES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	006966-1	NY
2	363A00000X	Physician Assistant	006966	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000560443011	OTHER		BC/BS
2	00026514404	OTHER		UNIVERA
3	9512047	OTHER		IHA
4	000560443006	OTHER	NY	BLUE CROSS/COMMUNITY BLUE
5	070924000060	OTHER		FIDELIS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114915287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE MARIE FRIES PA-C

Provider Business Mailing Address
First Line	:	4511 HARLEM ROAD
Second Line	:	SUITE 202
City	:	AMHERST
State	:	NY
Zip	:	14226-3822
Country	:	US
Telephone Number	:	716-839-6720
Fax Number	:	716-839-6740

Provider Business Practice Location Address
First Line	:	219 BRYANT STREET
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2006
Country	:	US
Telephone Number	:	716-250-6545
Fax Number	:	716-250-6566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/22/2008

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Directions to “ LYNNE MARIE FRIES PA-C” Practice Location

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