Provider Demographics
NPI:1841305349
Name:BETHIN, KATHLEEN E (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:BETHIN
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 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0300
Mailing Address - Fax:716-323-0599
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0170
Practice Address - Fax:716-323-0297
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2472252080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000529418001OtherBD/BS
0194393OtherGHI
080219000084OtherFIDELIS
1214441OtherIHA
00028296201OtherUNIVERA
NY02937924Medicaid
000529418001OtherBD/BS
RB7109Medicare PIN