Healthcare Provider Details

I. General information

NPI: 1679616601
Provider Name (Legal Business Name): LUCINDA BETH KILBURY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST BUFFALO GENERAL DEPT OF MED
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

PO BOX 8000 DEPT 164
BUFFALO NY
14026-0002
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-2091
  • Fax: 716-859-1471
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-213-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: