Basic Information
| Provider Information | |||||||||
| NPI: | 1538187059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARLOG | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARLOG | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | P | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3478 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142403478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166348800 | ||||||||
| FaxNumber: | 7166509622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3112 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166348800 | ||||||||
| FaxNumber: | 7166509622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 154494-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01051734 | 05 | NY | MEDICAID |