Provider Demographics
NPI:1417214271
Name:RIBBECK, AMANDA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:RIBBECK
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 1:190 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3129
Mailing Address - Country:US
Mailing Address - Phone:716-580-3810
Mailing Address - Fax:716-932-7094
Practice Address - Street 1:190 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-580-3810
Practice Address - Fax:716-932-7094
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0129194207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program