MEDICARE: MARY LOUISE LENAHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	153446-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0301329	OTHER	NY	IHA
2	000500619001	OTHER	NY	BCBS OF WNY
3	00010102801	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1144216953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOUISE LENAHAN MD

Provider Business Mailing Address
First Line	:	6507 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-689-4377
Fax Number	:	716-689-4843

Provider Business Practice Location Address
First Line	:	6507 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-689-4377
Fax Number	:	716-689-4843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	05/20/2019

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