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General NPI Number Information
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NPI Number | 1003006727
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Entity Type | Individual
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Provider Name | KATHERINE ANNE GAMBACORTA D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 30 S CAYUGA RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6728
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Country | US
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Telephone | 716-568-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 9785 ROCKY PT
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City | CLARENCE
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State | NY
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Zip | 14031-1589
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Country | US
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Telephone | 716-867-1417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34-008985
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License Number State | OH
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