Healthcare Provider Details

I. General information

NPI: 1518595909
Provider Name (Legal Business Name): NATHANIEL PAUL ROBERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 KENSINGTON AVE
AMHERST NY
14226-4927
US

IV. Provider business mailing address

330 W 4TH ST APT 21
CINCINNATI OH
45202-2655
US

V. Phone/Fax

Practice location:
  • Phone: 716-839-1700
  • Fax:
Mailing address:
  • Phone: 716-392-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number341298-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: