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General NPI Number Information
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NPI Number | 1205268877
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Entity Type | Individual
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Provider Name | MARIA ELIZABETH LAGOPOULOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 155 LAWN AVE STE 100
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City | BUFFALO
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State | NY
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Zip | 14207-1816
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Country | US
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Telephone | 248-849-3014
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Fax |
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Provider Business Mailing Address
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Address Line | 155 LAWN AVE STE 100
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City | BUFFALO
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State | NY
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Zip | 14207-1816
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Country | US
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Telephone | 716-875-2904
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301102574
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License Number State | MI
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