Provider Demographics
NPI:1427007095
Name:DEXTER, ELISABETH U (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:U
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ELM AND CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:716-845-7692
Practice Address - Street 1:ELM AND CARLTON STREETS
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-7692
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224564208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02298617Medicaid
NY02298617Medicaid
H20101Medicare UPIN