Provider Demographics
NPI:1124278841
Name:INTERLICHIA, JAMIE C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:C
Last Name:INTERLICHIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:C
Other - Last Name:CZARNECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:ELM AND CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant