Healthcare Provider Details

I. General information

NPI: 1831341643
Provider Name (Legal Business Name): KRISHNAKUMAR THANKAPPAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF HEAD AND NECK ROSWELL PARK CANCER ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

DEPT OF HEAD AND NECK ROSWELL PARK CANCER ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-830-4421
  • Fax:
Mailing address:
  • Phone: 716-830-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberP67652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: