Provider Demographics
NPI:1538187059
Name:BARLOG, ELIZABETH P (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:BARLOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:P
Other - Last Name:BARLOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3478
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3478
Mailing Address - Country:US
Mailing Address - Phone:716-634-8800
Mailing Address - Fax:716-650-9622
Practice Address - Street 1:3112 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1904
Practice Address - Country:US
Practice Address - Phone:716-634-8800
Practice Address - Fax:716-650-9622
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154494-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01051734Medicaid
NY01051734Medicaid