Healthcare Provider Details

I. General information

NPI: 1801851803
Provider Name (Legal Business Name): PETER A CAMPIONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 ABBOTT RD
BUFFALO NY
14220-1745
US

IV. Provider business mailing address

6255 SHERIDAN DR SUITE 304
WILLIAMSVILLE NY
14221-4836
US

V. Phone/Fax

Practice location:
  • Phone: 716-823-4962
  • Fax: 716-630-3681
Mailing address:
  • Phone: 716-857-8666
  • Fax: 716-857-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number136093-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: