Individual
MRS. AMY MARIE SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5430 MAIN ST, EGEA MEDICAL WEIGHT LOSS CENTER, WILLIAMSVILLE, NY 14221-6648
(716) 204-0707
Mailing address
5430 MAIN ST, EGEA MEDICAL WEIGHT LOSS CENTER, WILLIAMSVILLE, NY 14221-6648
(716) 204-0707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2235651
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02504814
—
NY
Enumeration date
06/14/2006
Last updated
04/11/2018
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