Provider Demographics
NPI:1720017825
Name:DITONTO, MD, ELIZABETH DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DENISE
Last Name:DITONTO, MD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7470
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3215
Practice Address - Fax:716-898-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197365208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720017825Medicaid
NY1720017825Medicaid
NY13011BMedicare PIN