MEDICARE: JOHN FUDYMA MD

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	207R00000X	Internal Medicine Physician	172763	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00010058701	OTHER	NY	EXCELLUS UNIVERA
3	0407602	OTHER	NY	INDEPENDENT HEALTH
4	005108981	OTHER	NY	HEALTH NOW

General Provider Information

NPI Number	:	1073562716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FUDYMA MD

Provider Business Mailing Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:	716-688-6501

Provider Business Practice Location Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:	716-688-6501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/27/2023

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