Healthcare Provider Details

I. General information

NPI: 1912985904
Provider Name (Legal Business Name): DIANE T. FLANIGEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 MAIN STREET
WILLIAMSVILLE NY
14221-5800
US

IV. Provider business mailing address

6333 MAIN STREET
WILLIAMSVILLE NY
14221-5800
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-3545
  • Fax: 716-632-6368
Mailing address:
  • Phone: 716-632-3545
  • Fax: 716-632-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number178565-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number178565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: