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NPI Code Detail

MEDICARE: JULIE A GAVIN MD

MEDICARE: JULIE A GAVIN 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
1207VX0000XObstetrics Physician243652NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1161021580OTHERNYTAX ID

General Provider Information

NPI Number : 1700083276
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A GAVIN MD
Provider Business Mailing Address
First Line : 1430 COLVIN BLVD
Second Line :
City : BUFFALO
State : NY
Zip : 14223-1440
Country : US
Telephone Number : 716-877-1221
Fax Number : 716-877-1096
Provider Business Practice Location Address
First Line : 1430 COLVIN BLVD
Second Line :
City : BUFFALO
State : NY
Zip : 14223-1440
Country : US
Telephone Number : 716-877-1221
Fax Number : 716-877-1096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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