Healthcare Provider Details

I. General information

NPI: 1336585769
Provider Name (Legal Business Name): ANDREW BENNETT NORDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST ROOM C-378
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

100 HIGH ST ROOM C-378
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-7756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number305187
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number305187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: