MEDICARE: THINFASTMD BUFFALO, WISDOM MEDICINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	263700	NY

General Provider Information

NPI Number	:	1053754044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THINFASTMD BUFFALO, WISDOM MEDICINE PLLC

Provider Business Mailing Address
First Line	:	7060 ERIE RD
Second Line	:	SUITE 100
City	:	DERBY
State	:	NY
Zip	:	14047-9430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 SHERIDAN DR
Second Line	:	SUITE 328
City	:	AMHERST
State	:	NY
Zip	:	14226-1439
Country	:	US
Telephone Number	:	716-898-8335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMED A MOHIUDDIN
Credential	:	M.D
Telephone Number	:	716-898-8335

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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