Healthcare Provider Details

I. General information

NPI: 1811143639
Provider Name (Legal Business Name): KRISTIN ELIZABETH POPPENBERG DUQUETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 N BUFFALO ST
ORCHARD PARK NY
14127-1934
US

IV. Provider business mailing address

3560 N BUFFALO ST
ORCHARD PARK NY
14127-1934
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-8510
  • Fax: 716-662-8574
Mailing address:
  • Phone: 716-662-8510
  • Fax: 716-662-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251812
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number251812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: