MEDICARE: DOROTHY L. TRUBISH 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	174400000X	Specialist	186192	NY

General Provider Information

NPI Number	:	1295817369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY L. TRUBISH MD

Provider Business Mailing Address
First Line	:	3030 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4638
Country	:	US
Telephone Number	:	716-671-2507
Fax Number	:	716-671-2508

Provider Business Practice Location Address
First Line	:	3030 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4638
Country	:	US
Telephone Number	:	716-671-2507
Fax Number	:	716-671-2508

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	11/04/2015

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