Provider Demographics
NPI:1881128007
Name:DOTHAN, DEGANIT (MD)
Entity type:Individual
Prefix:DR
First Name:DEGANIT
Middle Name:
Last Name:DOTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEGANIT
Other - Middle Name:
Other - Last Name:DOTHAN KESSLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:77 GOODELL ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-816-7228
Mailing Address - Fax:
Practice Address - Street 1:77 GOODELL ST
Practice Address - Street 2:SUITE 240
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1243
Practice Address - Country:US
Practice Address - Phone:716-816-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program