Healthcare Provider Details

I. General information

NPI: 1851467757
Provider Name (Legal Business Name): PHILIP M DVORETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

PO BOX 8000 DEPT 173
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-7000
  • Fax: 716-213-0348
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-213-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number137783
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number137783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: