Healthcare Provider Details

I. General information

NPI: 1013338052
Provider Name (Legal Business Name): SRIDHAR NILAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SWEET HOME RD SUITE 9
AMHERST NY
14228-2783
US

IV. Provider business mailing address

115 SPRING MEADOW DR APT #8
WILLIAMSVILLE NY
14221-8425
US

V. Phone/Fax

Practice location:
  • Phone: 716-247-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number270638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: