Healthcare Provider Details

I. General information

NPI: 1407439060
Provider Name (Legal Business Name): GRETCHEN MARIE DOTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 DELAWARE AVE
BUFFALO NY
14209-2202
US

IV. Provider business mailing address

8806 CHESTNUT RIDGE RD
GASPORT NY
14067-9346
US

V. Phone/Fax

Practice location:
  • Phone: 716-431-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: