Provider Demographics
NPI:1346515939
Name:AMES, KAITLIN MAE (DO)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MAE
Last Name:AMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6627
Mailing Address - Country:US
Mailing Address - Phone:716-488-1878
Mailing Address - Fax:716-661-4612
Practice Address - Street 1:15 S MAIN ST STE 250
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6627
Practice Address - Country:US
Practice Address - Phone:716-488-1878
Practice Address - Fax:716-661-4612
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277898-01207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04102338Medicaid
J400215991Medicare PIN