Provider Demographics
NPI:1982660205
Name:DENARDIN, ANN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MICHELLE
Last Name:DENARDIN
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 1:4949 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2500
Mailing Address - Country:US
Mailing Address - Phone:716-839-1690
Mailing Address - Fax:716-839-6743
Practice Address - Street 1:4949 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2500
Practice Address - Country:US
Practice Address - Phone:716-839-1690
Practice Address - Fax:716-839-6743
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219474207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02240040Medicaid
NY02240040Medicaid
NYBA0226Medicare ID - Type Unspecified