Provider Demographics
NPI:1033396148
Name:MEDICAL WEIGHT LOSS AND HEALTHCARE
Entity Type:Organization
Organization Name:MEDICAL WEIGHT LOSS AND HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-634-4798
Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7470
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:338 HARRIS HILL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7470
Practice Address - Country:US
Practice Address - Phone:716-634-4798
Practice Address - Fax:716-634-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227296Medicaid
NYBA1265Medicare PIN