MEDICARE: KAREN W WALCOTT M.D.

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	207W00000X	Ophthalmology Physician	247834	NY
2	207W00000X	Ophthalmology Physician	229139	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942232483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN W WALCOTT M.D.

Provider Business Mailing Address
First Line	:	89 MIDDLESEX RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-3617
Country	:	US
Telephone Number	:	716-359-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 SWEENEY ST
Second Line	:
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-5822
Country	:	US
Telephone Number	:	716-634-8500
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/30/2020

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