Healthcare Provider Details

I. General information

NPI: 1922279660
Provider Name (Legal Business Name): REBECCA E PRATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 DELAWARE AVE STE 100
BUFFALO NY
14209-1861
US

IV. Provider business mailing address

936 DELAWARE AVE STE 100
BUFFALO NY
14209-1861
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-5437
  • Fax: 716-885-7317
Mailing address:
  • Phone: 716-885-5437
  • Fax: 716-885-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number261563
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60 261563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: