Provider Demographics
NPI:1790710176
Name:SPRINGATE, LAURA M (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:SPRINGATE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2356 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1224
Mailing Address - Country:US
Mailing Address - Phone:716-505-5630
Mailing Address - Fax:716-892-1936
Practice Address - Street 1:7 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2523
Practice Address - Country:US
Practice Address - Phone:716-505-5630
Practice Address - Fax:716-892-1936
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570170002OtherBLUE CROSS/BLUE SHIELD
NY9512335OtherINDEPENDENT HEALTH
NYP00159788OtherMEDICARE RAILROAD
NY00021055902OtherUNIVERA
NY160757756001OtherTRICARE
NY000570170002OtherBLUE CROSS/BLUE SHIELD
NY9512335OtherINDEPENDENT HEALTH