Provider Demographics
NPI:1912996133
Name:O'DONNELL, KATHERINE A (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SPINDRIFT DR.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-626-6300
Mailing Address - Fax:716-626-6312
Practice Address - Street 1:55 SPINDRIFT DR STE 220
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-626-6300
Practice Address - Fax:716-631-6312
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198782208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148119FLOtherPREFERRED CARE
NY01956376Medicaid
NY040426002685OtherFIDELIS
NY00020516904OtherUNIVERA
NY000525717005OtherBC/BS
NY1710860OtherIHA
NY460020OtherWELLCARE
NY000525717005OtherBC/BS
NYDD4137Medicare PIN
020054349Medicare PIN