Healthcare Provider Details

I. General information

NPI: 1548274905
Provider Name (Legal Business Name): NADER DJALAL NADER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE VAMC, RM 203 C
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

3495 BAILEY AVE VAMC, RM 203 C
BUFFALO NY
14215-1129
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8707
  • Fax: 716-862-8709
Mailing address:
  • Phone: 716-862-8707
  • Fax: 716-862-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number208077
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number208077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: