Healthcare Provider Details

I. General information

NPI: 1144216953
Provider Name (Legal Business Name): MARY LOUISE LENAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 TRANSIT RD
EAST AMHERST NY
14051-1427
US

IV. Provider business mailing address

6507 TRANSIT RD
EAST AMHERST NY
14051-1427
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-4377
  • Fax: 716-689-4843
Mailing address:
  • Phone: 716-689-4377
  • Fax: 716-689-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number153446-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: