Provider Demographics
NPI:1235360629
Name:GUTIERREZ-PANCHAL, LYNDSAY ANN (MD)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:ANN
Last Name:GUTIERREZ-PANCHAL
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 1:180 PARK CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5263
Mailing Address - Country:US
Mailing Address - Phone:716-332-6834
Mailing Address - Fax:716-332-6856
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-332-6834
Practice Address - Fax:716-332-6856
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03237625Medicaid
NY03237625Medicaid