Provider Demographics
NPI:1437315215
Name:WYMER, DANA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:WYMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:RAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3560 N BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1934
Mailing Address - Country:US
Mailing Address - Phone:716-662-8510
Mailing Address - Fax:716-662-8574
Practice Address - Street 1:3560 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1934
Practice Address - Country:US
Practice Address - Phone:716-662-8510
Practice Address - Fax:716-662-8574
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250108207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000532405001OtherBLUE CROSS WNY