Provider Demographics
NPI:1952370884
Name:PESSAR, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PESSAR
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 1:462 GRIDER ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-4858
Mailing Address - Fax:716-898-4447
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4858
Practice Address - Fax:716-898-4447
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1096692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00194674Medicaid
NY00194674Medicaid
NYCC8272Medicare ID - Type Unspecified