Healthcare Provider Details

I. General information

NPI: 1841226966
Provider Name (Legal Business Name): DELAWARE MEDICAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 DELAWARE AVE
BUFFALO NY
14209-1635
US

IV. Provider business mailing address

1083 DELAWARE AVE
BUFFALO NY
14209-1635
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-1023
  • Fax: 716-882-1022
Mailing address:
  • Phone: 716-882-1023
  • Fax: 716-882-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SAMUEL HAAR
Title or Position: PRESIDENT
Credential:
Phone: 716-882-1023