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NPI Code Detail

MEDICARE: MRS. SUSAN GAYLE MCLANAHAN P.A.

MEDICARE: MRS. SUSAN GAYLE MCLANAHAN P.A.
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
1363AM0700XMedical Physician Assistant015188NY

General Provider Information

NPI Number : 1861779191
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN GAYLE MCLANAHAN P.A.
Provider Business Mailing Address
First Line : 9 FORESTGLEN CIR
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-1360
Country : US
Telephone Number : 716-631-5141
Fax Number :
Provider Business Practice Location Address
First Line : 1 JOHN JAMES AUDUBON PKWY
Second Line :
City : AMHERST
State : NY
Zip : 14228-1143
Country : US
Telephone Number : 716-204-4500
Fax Number : 716-204-4501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2011
Last Update Date : 11/15/2011

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