Provider Demographics
NPI:1558321372
Name:MECHTLER, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MECHTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-929-2600
Mailing Address - Fax:716-929-2493
Practice Address - Street 1:3890 SHERIDAN DR
Practice Address - Street 2:SUITE 400
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1723
Practice Address - Country:US
Practice Address - Phone:716-929-2600
Practice Address - Fax:716-929-2493
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183102207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01245174Medicaid
NY01245174Medicaid
NYE84828Medicare UPIN