Healthcare Provider Details

I. General information

NPI: 1649276189
Provider Name (Legal Business Name): ANDREW SOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

2157 MAIN ST
BUFFALO NY
14214-2648
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-2700
  • Fax: 716-961-2009
Mailing address:
  • Phone: 716-862-2700
  • Fax: 716-961-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number172437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: