MEDICARE: MRS. LAURA E JOSLYN RPA C

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	006502	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000570185001	OTHER	NY	BLUE CROSS
2	000570185001	OTHER	NY	COMM BLUE
3	9512235	OTHER	NY	INDEP HEALTH
4	00027195601	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1356324016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA E JOSLYN RPA C

Provider Business Mailing Address
First Line	:	960 CENTER RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14224-2332
Country	:	US
Telephone Number	:	716-674-8502
Fax Number	:	716-674-8504

Provider Business Practice Location Address
First Line	:	960 CENTER RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14224-2332
Country	:	US
Telephone Number	:	716-674-8502
Fax Number	:	716-674-8504

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

Provider Enumeration Date	:	11/26/2005
Last Update Date	:	08/20/2007

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