Provider Demographics
NPI:1356317341
Name:WLODAREK, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:WLODAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2515
Mailing Address - Country:US
Mailing Address - Phone:716-366-9008
Mailing Address - Fax:716-363-0445
Practice Address - Street 1:504 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2515
Practice Address - Country:US
Practice Address - Phone:716-366-9008
Practice Address - Fax:716-363-0445
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q56131Medicare UPIN
PA1122Medicare ID - Type Unspecified