Provider Demographics
NPI:1629317441
Name:ATTIA, WREIDA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:WREIDA
Middle Name:A
Last Name:ATTIA
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 1:268 W MAIN ST, SUITE 2
Mailing Address - Street 2:LAKE ERIE MEDICAL SERVICES, PC
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2200
Mailing Address - Country:US
Mailing Address - Phone:716-672-2000
Mailing Address - Fax:716-672-4414
Practice Address - Street 1:268 W MAIN ST, SUITE 2
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2200
Practice Address - Country:US
Practice Address - Phone:716-672-2000
Practice Address - Fax:716-672-4414
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY281162OtherLICENSE