Healthcare Provider Details

I. General information

NPI: 1376964973
Provider Name (Legal Business Name): HATOON BAKHRIBAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM & CARLTON STREETS ROSWELL PARK CANCER INSTITUTE
BUFFALO NY
14263
US

IV. Provider business mailing address

ELM & CARLTON STREETS ROSWELL PARK CANCER INSTITUTE
BUFFALO NY
14263
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-4101
  • Fax:
Mailing address:
  • Phone: 716-845-4101
  • Fax: 716-845-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberP90-532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: