Provider Demographics
NPI:1679616601
Name:KILBURY, LUCINDA BETH (PA)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:BETH
Last Name:KILBURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 164
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14026-0002
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0935
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:BUFFALO GENERAL DEPT OF MED
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2091
Practice Address - Fax:716-859-1471
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006699363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9514354OtherIHA
NY00028109101OtherUNIVERA
NYPA1954Medicare PIN