Healthcare Provider Details

I. General information

NPI: 1366413734
Provider Name (Legal Business Name): CHARLES S. TIRONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

405 N FRENCH RD SUITE 104
AMHERST NY
14228-2010
US

V. Phone/Fax

Practice location:
  • Phone: 716-649-9000
  • Fax: 716-649-9005
Mailing address:
  • Phone: 716-689-1901
  • Fax: 716-564-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number097861-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number097861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: