Healthcare Provider Details

I. General information

NPI: 1942232483
Provider Name (Legal Business Name): KAREN W WALCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 SWEENEY ST
N TONAWANDA NY
14120-5822
US

IV. Provider business mailing address

89 MIDDLESEX RD
BUFFALO NY
14216-3617
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-8500
  • Fax:
Mailing address:
  • Phone: 716-359-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number247834
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number229139
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: