Healthcare Provider Details

I. General information

NPI: 1245650084
Provider Name (Legal Business Name): MARIA GRACE LENNOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N BUFFALO ST
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-656-4988
  • Fax: 716-817-1719
Mailing address:
  • Phone: 716-630-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number296907-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: