Provider Demographics
NPI:1942282207
Name:RAND, LAWRENCE G (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:G
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:4925 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4000
Practice Address - Country:US
Practice Address - Phone:716-839-3333
Practice Address - Fax:716-839-3338
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010598112085R0202X
NY1347892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5607927OtherIHA
NY02271878Medicaid
NY01086268Medicaid
NYP00804125OtherRAILROAD MEDICARE
IN200503240Medicaid
IN211820EMedicare PIN
NY5607927OtherIHA
NY01086268Medicaid
NYJ400008109Medicare PIN