Provider Demographics
NPI:1134207582
Name:GARTNER, LOU ANN (MD)
Entity type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:GARTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4511 HARLEM RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:ENDOCRINOLOGY/DIABETES DIVISION
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7262
Practice Address - Fax:716-888-3827
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1716342080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01078317Medicaid
NY040426001274OtherFIDELIS
NY4508512OtherIHA
NY0016896770001OtherPA MEDICAID
NY00010293201OtherUNIVERA
NY000524607001OtherBC/BS
NY01078317Medicaid
G68691Medicare UPIN