Provider Demographics
NPI:1487920609
Name:LORE, ANGELA D (RPA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:LORE
Suffix:
Gender:F
Credentials:RPA
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:STE 108
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4825
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8615
Practice Address - Fax:716-250-5942
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2017-03-17
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Provider Licenses
StateLicense IDTaxonomies
NY015524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant