Healthcare Provider Details

I. General information

NPI: 1356388029
Provider Name (Legal Business Name): KATHLEEN DYSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 N BUFFALO ST SUITE A
ORCHARD PARK NY
14127-1853
US

IV. Provider business mailing address

3725 N BUFFALO ST SUITE A
ORCHARD PARK NY
14127-1853
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-2300
  • Fax: 716-662-2057
Mailing address:
  • Phone: 716-662-2300
  • Fax: 716-662-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209548-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: