Provider Demographics
NPI:1821353251
Name:INNES, JOHANNA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CHRISTINE
Last Name:INNES
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 1:462 GRIDER ST
Mailing Address - Street 2:UNIVERSITY EMERGENCY MEDICAL SERVICES
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-4430
Mailing Address - Fax:716-898-4432
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:UNIVERSITY EMERGENCY MEDICAL SERVICES
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4430
Practice Address - Fax:716-898-4432
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278801207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine