MEDICARE: DR. VYJANTHANATH ROHAN GUNASINGHAM M.D.

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	249369	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0415102	OTHER	NY	INDEPENDENT HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000530664001	OTHER	NY	BLUE CROSS BLUE SHIELD
4	080924000024	OTHER	NY	FIDELIS

General Provider Information

NPI Number	:	1912900432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VYJANTHANATH ROHAN GUNASINGHAM M.D.

Provider Business Mailing Address
First Line	:	725 ORCHARD PARK RD
Second Line	:	STE D
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3352
Country	:	US
Telephone Number	:	716-748-6002
Fax Number	:	716-210-6252

Provider Business Practice Location Address
First Line	:	725 ORCHARD PARK RD
Second Line	:	STE D
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3352
Country	:	US
Telephone Number	:	716-667-3200
Fax Number	:	716-667-3213

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	01/09/2017

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