MEDICARE: LYNDA M SORENSEN MD

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	207N00000X	Dermatology Physician	173722	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070017414	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0307845	OTHER	INDEPENDENT HEALTH
2	000510939001	OTHER	BCBS WNY
4	00010170501	OTHER	UNIVERA

General Provider Information

NPI Number	:	1518927136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA M SORENSEN MD

Provider Business Mailing Address
First Line	:	12 WHITING ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6124
Country	:	US
Telephone Number	:	716-694-8851
Fax Number	:	716-694-5941

Provider Business Practice Location Address
First Line	:	12 WHITING ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6124
Country	:	US
Telephone Number	:	716-694-8851
Fax Number	:	716-694-5941

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	11/16/2011

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Directions to “ LYNDA M SORENSEN MD” Practice Location

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