Provider Demographics
NPI:1699726745
Name:GASS, FREDERICK CARLTON (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CARLTON
Last Name:GASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-675-0616
Mailing Address - Fax:716-675-7101
Practice Address - Street 1:3075 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-675-0616
Practice Address - Fax:716-675-7101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209113207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG75600Medicare UPIN
NYCC1244Medicare ID - Type UnspecifiedMEDICARE PROVIDER #