Basic Information
| Provider Information | |||||||||
| NPI: | 1134207582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARTNER | ||||||||
| FirstName: | LOU ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4511 HARLEM RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142263822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168396720 | ||||||||
| FaxNumber: | 7168396740 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 BRYANT ST | ||||||||
| Address2: | ENDOCRINOLOGY/DIABETES DIVISION | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142222006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168787262 | ||||||||
| FaxNumber: | 7168883827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 09/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 171634 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 01078317 | 05 | NY | MEDICAID | 040426001274 | 01 | NY | FIDELIS | OTHER | 4508512 | 01 | NY | IHA | OTHER | 0016896770001 | 01 | NY | PA MEDICAID | OTHER | 00010293201 | 01 | NY | UNIVERA | OTHER | 000524607001 | 01 | NY | BC/BS | OTHER |