Healthcare Provider Details

I. General information

NPI: 1912601931
Provider Name (Legal Business Name): CHARLES DEVON WALDROFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 GOODELL ST STE 340
BUFFALO NY
14203-1243
US

IV. Provider business mailing address

955 MAIN ST STE 7230
BUFFALO NY
14203-1121
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2012
  • Fax: 716-829-3999
Mailing address:
  • Phone: 716-829-2012
  • Fax: 716-829-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME178148
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: