Provider Demographics
NPI:1073066882
Name:BERNOTAS, ASHLEY CLAIRE ELEANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:CLAIRE ELEANOR
Last Name:BERNOTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HIGH ST # D3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1126
Mailing Address - Country:US
Mailing Address - Phone:716-859-1168
Mailing Address - Fax:716-859-3352
Practice Address - Street 1:100 HIGH ST # D3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-1168
Practice Address - Fax:719-859-3352
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299524207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05773148Medicaid