Healthcare Provider Details

I. General information

NPI: 1528063237
Provider Name (Legal Business Name): MAURICE BARCOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-8077
Mailing address:
  • Phone: 716-845-2300
  • Fax: 716-845-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number117089
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number117089
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number117089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: