Provider Demographics
NPI:1316012560
Name:ODONNELL, PATRICIA A (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6800
Mailing Address - Country:US
Mailing Address - Phone:716-635-0688
Mailing Address - Fax:716-204-9574
Practice Address - Street 1:100 COLLEGE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-635-0688
Practice Address - Fax:716-204-9574
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY238555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02876713Medicaid
NY02876713Medicaid