Basic Information
| Provider Information | |||||||||
| NPI: | 1063944601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEHLER | ||||||||
| FirstName: | ALANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 ASHLAND AVE | ||||||||
| Address2: | APT 5 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142221794 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 818 ELLICOTT ST | ||||||||
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| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163232000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2017 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 313579 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.