Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 025488 | NY |
N | 2086S0122X | Plastic and Reconstructive Surgery | 025488 | NY |
NPI | 1033686340 |
---|---|
Provider Name | Carolyn Marie Cormier |
First Address | Buffalo, NY 14209-1674 |
Second Address | Buffalo, NY 14209-1674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 31/08/2020 |