Healthcare Provider Details

I. General information

NPI: 1245359819
Provider Name (Legal Business Name): DIANNE VERTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

8367 BLACK WALNUT DR
EAST AMHERST NY
14051-1562
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-7591
  • Fax:
Mailing address:
  • Phone: 716-741-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number228861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: