Healthcare Provider Details

I. General information

NPI: 1922041771
Provider Name (Legal Business Name): CARDIOLOGY READING PANEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GATES CIR
BUFFALO NY
14209-1120
US

IV. Provider business mailing address

3 GATES CIR
BUFFALO NY
14209-1120
US

V. Phone/Fax

Practice location:
  • Phone: 716-887-4093
  • Fax: 716-887-5540
Mailing address:
  • Phone: 716-887-4093
  • Fax: 716-887-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: WILSON MICHAEL
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 716-887-4093