Provider Demographics
NPI:1942232483
Name:WALCOTT, KAREN W (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:W
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:89 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3617
Mailing Address - Country:US
Mailing Address - Phone:716-359-3364
Mailing Address - Fax:
Practice Address - Street 1:84 SWEENEY ST
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-5822
Practice Address - Country:US
Practice Address - Phone:716-634-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247834207W00000X
MA229139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102026377Medicaid
PA115357E41Medicare PIN
PA102026377Medicaid