MEDICARE: HELEN DOEMLAND PA

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	363A00000X	Physician Assistant	009996	NY

General Provider Information

NPI Number	:	1265438667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN DOEMLAND PA

Provider Business Mailing Address
First Line	:	317 NORWOOD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-1701
Country	:	US
Telephone Number	:	716-870-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	10440 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1627
Country	:	US
Telephone Number	:	716-759-8363
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/27/2012

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Directions to “ HELEN DOEMLAND PA” Practice Location

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