Provider Demographics
NPI:1841406022
Name:BASS, KATHRYN D (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:BASS
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 1:148 SOLDIERS PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1260
Mailing Address - Country:US
Mailing Address - Phone:716-704-9070
Mailing Address - Fax:
Practice Address - Street 1:219 BRYANT ST.
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7137
Practice Address - Fax:716-878-7809
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM98372086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750369203OtherGROUP NPI
TX137345810Medicaid
TX140442852Medicaid
TX189282002Medicaid
TX189282003Medicaid
1750369203OtherGROUP NPI
TX189282002Medicaid