Provider Demographics
NPI:1376529164
Name:GAINES, KATHERINE C (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:GAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 LAKEFRONT BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4345
Mailing Address - Country:US
Mailing Address - Phone:716-849-8750
Mailing Address - Fax:716-849-8757
Practice Address - Street 1:50 LAKEFRONT BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4345
Practice Address - Country:US
Practice Address - Phone:716-849-8750
Practice Address - Fax:716-849-8757
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY153168207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010059307OtherUNIVERA
NY00776650Medicaid
NY000500104008OtherBLUE CROSS
NY2305778OtherIHA
NY2305778OtherIHA
NMRB1586Medicare PIN