Provider Demographics
NPI:1962474262
Name:MERAS, LARISA (MD)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:MERAS
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-1848
Mailing Address - Country:US
Mailing Address - Phone:716-923-4385
Mailing Address - Fax:716-246-4433
Practice Address - Street 1:705 RENAISSANCE DRIVE
Practice Address - Street 2:CANTERBURY WOODS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-8052
Practice Address - Country:US
Practice Address - Phone:716-650-9760
Practice Address - Fax:716-650-9622
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524321010OtherBC/BS
NY0409145OtherIHA
NY040511000694OtherFIDELIS
NY151121BJOtherPREFERRED CARE
NY01665067Medicaid
NY00010198905OtherUNIVERA
NY000524321010OtherBC/BS
NY01665067Medicaid