Healthcare Provider Details

I. General information

NPI: 1790710176
Provider Name (Legal Business Name): LAURA M SPRINGATE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COMMUNITY DR
BUFFALO NY
14225-2523
US

IV. Provider business mailing address

2356 N FOREST RD
GETZVILLE NY
14068-1224
US

V. Phone/Fax

Practice location:
  • Phone: 716-505-5630
  • Fax: 716-892-1936
Mailing address:
  • Phone: 716-505-5630
  • Fax: 716-892-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: