Provider Demographics
NPI:1164524708
Name:LUTHER, PRAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMA
Middle Name:
Last Name:LUTHER
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 1:200 HALSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1856
Mailing Address - Country:US
Mailing Address - Phone:716-688-8052
Mailing Address - Fax:
Practice Address - Street 1:2671 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4019
Practice Address - Country:US
Practice Address - Phone:716-895-1410
Practice Address - Fax:716-895-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01830322Medicaid
000523457002OtherBLUE SHIELD
00010107401OtherUNIVERA
6409973OtherINDEPEDENT HEALTH
00010107401OtherUNIVERA
NY01830322Medicaid