Basic Information
| Provider Information | |||||||||
| NPI: | 1841305349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETHIN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 MAIN ST FL 5 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163230225 | ||||||||
| FaxNumber: | 7163230599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163230170 | ||||||||
| FaxNumber: | 7163230297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 247225 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 00028296201 | 01 | UNIVERA | OTHER | 02937924 | 05 | NY | MEDICAID | 0194393 | 01 | GHI | OTHER | 080219000084 | 01 | FIDELIS | OTHER | 000529418001 | 01 | BD/BS | OTHER | 1214441 | 01 | IHA | OTHER |