Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 279874 | NY |
NPI | 1376825646 |
---|---|
Provider Name | Dr. Katherine Anne Mager |
First Address | Buffalo, NY 14263-0001 |
Second Address | Buffalo, NY 14263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279874 | NYS LICENSE (01) | NY |