Provider Demographics
NPI:1790899144
Name:ROESSLER, LORI A (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:ROESSLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:1185 SWEET HOME RD
Practice Address - Street 2:AMHERST UNIVERSITY HEALTH CENTER
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-689-0040
Practice Address - Fax:716-568-2330
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070206000001OtherFIDELIS LEGACY#
NY000924732003OtherHEALTH NOW BCBS LEGACY#
NY00026959502OtherUNIVERA LEGACY#
NY08494418Medicaid
NY9512762OtherIHA LEGACY#
NY195030BFOtherPREFERRED CARE #
NY070320000056OtherFIDELIS # FOR URGENT CARE
NY00026959502OtherUNIVERA LEGACY#
NY000924732003OtherHEALTH NOW BCBS LEGACY#