Provider Demographics
NPI:1174589352
Name:CARR, MICHELE (DDS,MD,PHD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:DDS,MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 MAIN STREET SUITE 5
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-632-2000
Mailing Address - Fax:716-632-2162
Practice Address - Street 1:8207 MAIN STREET SUITE 5
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-632-2000
Practice Address - Fax:716-632-2162
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421761207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019546130001Medicaid
PA0019546130001Medicaid
PA71216Medicare ID - Type Unspecified