Provider Demographics
NPI:1144216953
Name:LENAHAN, MARY LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:LENAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1427
Mailing Address - Country:US
Mailing Address - Phone:716-689-4377
Mailing Address - Fax:716-689-4843
Practice Address - Street 1:6507 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1427
Practice Address - Country:US
Practice Address - Phone:716-689-4377
Practice Address - Fax:716-689-4843
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153446-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0301329OtherIHA
NY000500619001OtherBCBS OF WNY
NY00010102801OtherUNIVERA
NYB35597Medicare UPIN
NY006191Medicare PIN