Provider Demographics
NPI:1861439879
Name:DANAHER, PATRICIA J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:DANAHER
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 1:5949 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9204
Mailing Address - Country:US
Mailing Address - Phone:716-778-8627
Mailing Address - Fax:716-778-8059
Practice Address - Street 1:5949 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9204
Practice Address - Country:US
Practice Address - Phone:716-778-8627
Practice Address - Fax:716-778-8059
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335371Medicaid
NYH37390Medicare UPIN
NYRA2724Medicare ID - Type UnspecifiedMEDICARE